Inguinal Lymph Nodes
I have a 2 year old daughter who I have noticed has a "bird's egg" sized lump on the crease of her leg. (What adult women would consider their bikini line). I have read articles about boys having this, but I wasn't sure if it were the same thing in a girl. I haven't noticed any sign of rash or infection in that area that would cause a swollen lymph node, but wasn't sure what else it may be. Also, how soon do I need to get her in to see the doctor? We have an appointment for one week from today, isthat soon enough?
Dear “Concerned Mother”,
The examination by your physician will be able to tell you if the lump that you are seeing is a normal lymph node, an enlarged lymph node or something else. The inguinal area or bikini line is one of the areas that superficial lymph nodes can be seen and felt.(1) The swelling of an inguinal lymph node can represent the break down of cells or infection in the area. Lymph nodes in the inguinal area drain different parts of the body depending upon where the lymph node is located.
Yes it is true that a skin rash, bug bite, scratch or skin infection could cause a lymph node to enlarge. The enlargement of a lymph node can also represent a condition that may not be readily seen. Inguinal lymph nodes in the horizontal group are located high in the anterior thigh and drain the superficial portions of the lower abdomen and buttock, the external genitalia (but not the testes in males), the anal canal and perianal area and the lower vagina. (1) The inguinal lymph nodes in the vertical group are located below the horizontal group and drain the area around the thigh. Therefore a condition affecting the anus which may not be noticeable to a parent can cause swelling of the inguinal lymph nodes. That is why it is necessary to have a doctor perform a complete history and physical examination on a child with enlarged lymph nodes in order to determine the cause.
I have seen many young children who were brought to the office because their parent noticed a lump in the groin area. In most of the cases the lump turned out to be a normal lymph node. I found that the inguinal lymph nodes were more readily seen by a parent when the child was thin.
What you read about boys and lumps in the groin area most likely was referring to Inguinal Hernias. Inguinal hernias are the most common type of abdominal hernia. (2,3) The type of swelling caused by a hernia is much different than the swelling caused by an enlarged lymph node. A lymph node is an oval shaped rubbery, movable nodule located just under the surface of the skin. When a lymph node enlarges, the capsule becomes more visually noticeable and can easily be felt. A hernia on the other hand is more of a protrusion. The protrusion from a hernia looks like a bulge. This bulging increases in size when a child cries, coughs, engages in strenuous activity or has a bowel movement.(2)
Although Inguinal hernias are found in both boys and girls, they are much less common in girls.(1) The physical findings of a girl with an inguinal hernia are also different. Typically females present with a bulge in the area of their labia not in the crease of the leg.
If your daughter has no other symptoms it is reasonable to wait a week for an appointment. If she has a fever, swollen lymph nodes in other parts of her body, weight loss, pain or itching in her rectal area, problems having a bowel movement, change in her urinary pattern, increasing size of the lump, pain in the area, limping or redness around the area, then you should make an appointment sooner.
If you are interested in reading other Pediatric advice stories concerning this topic:
Lump in the Groin
(1)Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:438,400.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 1458-1459.
(3)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:422.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Parents