What is the treatment for swollen lymph nodes on the back of my child's neck and repeated fever?
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For the past 7 months i've been dealing with a sick 3 year old. It started with swollen lymph nodes on the back of her neck on both sides, like a spine that wont go away. A constant low grade fever of 99.8 and every couple of days rising to 101. In this 7 months she has had a fever over 102 at least every month. Along with this is extreme constipation. She has had an x-ray done, which showed her backed up under her rip cage. She has belly pain, which i can only assume its from the constipation. My doctor has had her on Apo-lactulose 667 mg/ml ( 3 doses of 15ml a day) and one dose of clearlax polyethylene glycol 3350 for the past 6 months. My Doctor just want to keep upping her doses of laxative and i don't think this is the solution anymore. When her fever gets higher my Doctor prescribes antibiotics. I'm at a lose on what to do...today she has a fever of 103.9....please help
Posted Sat, 25 Jan 2014 in Infections
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: Detailed investigation work up for fever require Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day It's quite common for children to have repeated fever and infection. I do understand your concern and apprehension of monthly fever and persistent lymph node. Let's start analysing her problems. She basically has two different problem 1. Fever with persistent lymph node swelling. 2. Chronic Constipation Let's analyse the first one. Recurrent fever especially every month along with persistent lymph node requires further assessment and investigation. If the lymph nodes are only at one location and smaller then 1 cm it's unlikely to be of much clinical significance. I would suggest the following investigation to arrive at cause for fever( fever is not a disease but it's a cardinal manifestation of underlying disease process ) 1. Complete Blood count 2. Chest X ray : to rule out any focus of infection in chest 3. Urine examination: to rule out urinary tract infection 4. Ultrasound of the lymph node and if required fine needle aspiration cytology. ( I would like to know the exact location of lymph node, providing clinical photograph will be appreciated) I suggest you to discuss it with your Pediatrician and things can be planned. Coming to constipation. Following are the commonest causes of constipation in children 1. Decreased intake of water 2. Decreased consumption of fiber in diet. 3. Presence of painful anal condition like fissure I hope fissure has been ruled out in your child. Apart from the laxative I would suggest you the following which I am definitely sure will help your kid too as it has helped majority of my patients 1. Retention Enema with Normal saline and glycerine: it will help in evacuation of loaded colon 2. Ensuring good intake of water. 3. High fiber diet: Suggest you to add vegetables salad and a serving of citrus fruit. Avoid fruit juice as they are deficient in fiber 4. Avoid constipation causing diet: Food stuff containing refined wheat flour and refined sugar. Diet modification, water intake and enema form a combined integral part of the management. In non responding cases possibility of Hirschsprung disease has to be considered. I suggest you to consult a Pediatric Surgeon for further management. In case you require any further assistance, will be glad to assist you. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric Surgeon
Follow-up: What is the treatment for swollen lymph nodes on the back of my child's neck and repeated fever? 6 hours later
Thank you for your reply. I've had her blood count done and nothing alarming came up. MY Doctor says not to worry about her lymph nodes, even though they have been there for 7 months now. As for diet we have had her on a high fiber diet and for the most part my child eats really well, when she does eat. Lately she doesn't want to eat at all and her tummy is always swollen. Do you know why my doctor won't give her an enema? Should I be taking her to see another Doctor. We've also had a chest xray done and she was on one round of antibiotics for an infection. Do you think that it is necessary for a young child to be on antibiotics and laxatives for a long period of time? Thank you again!
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: Enema will be definitely be helpful Detailed Answer: Greetings In the Presence of distension of abdomen, enema is definitely indicated. It will help in evacuation of colonic content and decrease the distension. It has helped in all my patients and hope the same in your child. Long term antibiotic is not advisable. Also the child needs to slowly tapered off laxative to facilitate completely stopping it. Diet modification and enema are cornerstone of treatment. Categorising the lymph node if it's clinical significant depends on clinical examination . Size , consistency and location are deciding factor. I would suggest you to discuss this with your Physician for further management. Get back if you need any further assistance Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric Surgeon