When it comes to diagnosing the “lumps and bumps” that parents sometimes find on a child’s head and neck, ENT (ear, nose and throat) specialist Steven Rosenblatt, MD, encourages parents to remember that “hoof beats usually mean horses, not zebras.”
“Common things tend to present commonly,” says Dr. Rosenblatt, assistant professor in the department of otolaryngology-head and neck surgery at NewYork Presbyterian-Weill Cornell Medicine. “The vast majority of head and neck masses are benign and non-cancerous.”
Typically, he explains, parents bring children to him for masses that turn out to be swollen lymph nodes.
“We have hundreds of lymph nodes in our head and neck in designated locations that are like a subway system, where the lymph nodes are the subway stops for white blood cells that exchange information about infection,” Dr. Rosenblatt says. “When we’re sick with a virus or a bacterial infection, the lymph nodes can swell.”
A viral infection would usually lead to symmetrical swelling—so swelling would appear on both sides of the neck. They’re not red or warm, but can be ender to the touch.
“These masses rarely go on to become anything else,” Dr. Rosenblatt explains. “They usually resolve on their own in a week or two, as a virus runs its course.”
Bacterial infections present differently.
“Think solitary, unilateral, big, and angry,” Dr. Rosenblatt notes.
A bacterial infection could lead to a mass that’s asymmetrical and discolored. If an abscess forms, it may require draining or antibiotics. (Antibiotics would not be used to treat a virus-based mass.)
There also are certain benign congenital bumps that parents may not see until babies are a bit bigger and their necks grow longer to make masses more visible.
“In this case, a thorough medical history and exam are important,” Dr. Rosenblatt says. “We want to know the history of when the mass was noticed, whether there were illnesses proceeding it, and whether the mass has been rapid or slow-growing.”
Even benign congenital masses can be prone to infection, however, so a physician may recommend having them removed.
Dr. Rosenblatt adds that biopsies for pediatric head and neck masses are less common than they are for adults, and are reserved more for lymph nodes and persistent infection. Because children need general anesthesia for either a biopsy or excising a mass, the mass would usually be removed.
Of course, there are occasional times when a mass isn’t benign.
“Head and neck cancer in kids is exceedingly rare,” Dr. Rosenblatt says. “And typically, that cancer would be lymphoma, which uses a biopsy to make a diagnosis, and is treated medically.”