Q: My three years old son has been suffering from occasional throat infections, fever and viral infections. I have observed small swelling nodules in the occipital region behind his head, where the hair line ends two and a half years back. The glands about 9-10 in number (I assume are lymph nodes) are oval and freely moveable and palpable in various size, starting from 1/2 cm to 1 inch and after a while all get subsided. A month back, I have noticed small rubbery glands on the lateral side on his neck. There are about 4 of them in a row with about an inch to 2 inches gap between them. The glands close to the clavicle have decreased in size. However, two close to the ear have grown. They were about half a centimetre and now have grown to one centimetre. Also I have noticed 2-3 new glands on the occipital area about an inch in size. We consulted a doctor who has been examining the baby for a year now. He has asked us to ignore them and told that they will go away and prescribed an antibiotic Clamp-kid for 5 days. The problem still persists and has not subsided. After that we have taken him to a general physician, who has suggested a lot of tests including blood tests and FNAC, we have got a lateral X-ray of skull and full chest done. The report has come out to be normal. Should we really get the blood tests and FNAC done? What should be done to get rid of extra glands?

A:You have written that your child is at present nearly 3 years in age. At the age of six months, he had some lymph nodal swellings at the nape of his neck, which subsided with an antibiotic. Within the last one month, he had developed some lymph nodal swellings at the sides of the front of neck. The first doctor had given a course of antibiotic. At the end of this one course of 5 days, you had taken the child to a different doctor. He in turn had advised you to get some tests done. You had mentioned that you had not carried out the tests, so far.

In my opinion, both these doctors had done the right things. The practice of giving an initial course of antibiotic for such conditions stands to reason. When the second doctor found that the response is inadequate, he had advised some tests. His advice is also correct. Please do them. The tests you have mentioned are straightforward tests. They involve no more pain than two injections. They may give valuable information. If the doctor finds that the information is inadequate again, he may ask you to have the nodes removed and tested in the laboratory under the microscope. This procedure is called biopsy and histopathological examination. If that be the case, you would be well advised to have that also.