A child with cervical lymphadenopathy.

Palpable lymphadenopathy is common in children, with studies showing a prevalence of 55% in children aged 6– 12 months and 41% in children aged 2–5 years. The majority of palpable lymph nodes are reactive, and serious pathology is rare. The challenge is to find clinical, radiological and serological evidence that is reliable enough to exclude malignancy (most likely lymphoma). This is a very different situation from that in adults, which is to confirm the suspicion of malignancy (usually carcinoma). • Recent upper respiratory tract infections including otitis media and tonsillitis commonly lead to lymphadenopathy, which usually resolves with treatment of the underlying condition. • Skin conditions, particularly those affecting the scalp are also a common cause of reactive lymphadenopathy. • Weight loss, night sweats and fever suggest serious pathology and should lead to prompt and thorough investigation. • Fluctuation in the size of the nodes is very suggestive of a reactive process: serious pathology tends to grow inexorably.