This is an urgent surgical condition.

Assessment and when to refer

History and physical examination

• Reactive
  • Mobile, non-tender and < 1.5 cm
  • No treatment required and referral not necessary.
    • Surgeons happy to see and reassure - non-urgent referral.
    • Please provide history and any investigations undertaken.
      
      
• Acute infective (Staph or Strep)
  • Sudden onset with tenderness and erythema.
  • Often recent URTI.  
  • If seen early start Augmentin and follow-up closely.
    • Refer for surgical opinion if no improvement after 48 hours or fluctuance.
    • Please provide history and any investigations undertaken.
      
      
• Atypical TB
  • May present as a slowly evolving infective process, as a node not responding to antibiotics, or with clinical features similar to a neoplastic lymph node. 
  • Antibiotics have no role.
    • Refer all cases for General Surgical review.
    • Please provide history and any investigations undertaken.
      
      
• Neoplastic
  • Hard, immobile, persistent and > 2 cm.
    • IMMEDIATE REFERRAL to General Surgery Outpatients
    • Fax referral to 03 9345 5034 and call 03 9345 6180 to note urgent referral.
    • Please provide history and any investigations undertaken.

Resources

• Make a referral:Specialist Clinics
• Contacts
• RCH Primary Care Liaison (GP website)
• Kids Health Info (Parent information website)  

References and more reading

• Paediatric Handbook (2009). Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia.

Thanks to Consultant Paediatric Surgeon Tom Clarnette for permission to adapt existing guidelines. Many thanks to the GPs involved in the review. First published Dec 2007.  Reviewed August 2009. Please read Copyright and Disclaimer.