How should I approach the management of a child presenting with a neck lump that is suspected to be a reactive lymph node?

When managing a child presenting with a neck lump suspected to be a reactive lymph node, the initial approach should focus on a thorough clinical assessment to identify features suggestive of benign reactive lymphadenopathy versus those warranting urgent investigation or referral. Start with a detailed history and physical examination, noting the lump's size, consistency, tenderness, duration, and any associated systemic symptoms such as fever, night sweats, weight loss, pruritus, or splenomegaly, which may indicate malignancy and require urgent referral within 48 hours ¹.

Reactive lymph nodes are typically small, mobile, tender, and associated with recent or concurrent infection, often resolving spontaneously. In the absence of red-flag symptoms or signs, conservative management with observation and symptomatic treatment is appropriate initially ¹ (King, 2017).

If the lymphadenopathy is generalized or persistent beyond a few weeks, or if systemic symptoms are present, further investigations are indicated. A very urgent full blood count should be offered within 48 hours to exclude leukaemia in children and young people with generalized lymphadenopathy ¹.

Referral for specialist assessment should be considered urgently if there are concerning features such as unexplained night sweats, weight loss, pruritus, splenomegaly, or if the lump is hard, fixed, non-tender, or progressively enlarging ¹. Ultrasound imaging may be used to further characterize the lump if clinical uncertainty persists, and if ultrasound suggests malignancy or is inconclusive, urgent referral is warranted ¹ (King, 2017).

Parental concern should also be taken seriously, and persistent anxiety about the lump despite likely benign cause may justify referral ¹.

In summary, the management of a suspected reactive lymph node in a child involves careful clinical evaluation, watchful waiting in typical benign cases, prompt blood tests if generalized lymphadenopathy is present, and urgent referral if red-flag symptoms or signs arise, integrating clinical judgement with parental insight ¹ (King, 2017).