Decoding Swelling

Swelling in a child can happen for different reasons, but most commonly happens after trauma or medical condition. Another common cause of swelling is a condition called lymphedema. Since I often work children with lymphedema, parents will ask me questions regarding the cause of their child’s swelling and how they can help.

Lymphedema is an abnormal collection of protein-rich fluid. In children, it is usually caused by an under development or over development of the lymphatic vessels. If the lymphatic vessels are damaged from trauma or cancer, there can also be an abnormal collection of fluid. The lymphatic system is one of the three fluid systems that run through our body. The other two are the venous and arterial system. All three work closely together to control the fluid in our body.

Getting to the bottom of it

I always start off by asking if the child has had any injury or trauma to the area of concern. I ask this because it is common after an injury or surgery to have inflammation in the area that is not lymphedema. During the healing phase inflammation is necessary to help the injured tissues heal and regrow.

What happens if time has passed and the area is still swollen?

Whenever there is an injury, there are three healing phases the body must go through. It is very common to see swelling, (often called edema) in all three phases. The last stage of healing can often last many months, and so it is very common to see swelling long after an injury.

What does it mean if my child has swelling to an area that has not been injured?

If you notice that your child has swelling to an uninjured limb or area of the body, here are two other questions you should ask to determine the best course of action.

• Was my child born with a limb or area of the body with increased fluid, or develop it shortly after birth

If you answer yes, there may be a problem with the internal fluid triad mentioned earlier. As we develop in the womb, sometimes the vessels of our lymphatic, venous, or arterial system do not develop properly. There can be overgrowth, undergrowth, or twisting and tangling of the vessels. Any of these three can lead to increased fluid in that area. You should bring this up to your doctor right away so diagnostic tests can be run. If the tests come back positive, the doctors will refer your child to a specialist like me who can help with the edema.

• Did the excess fluid show up later in life with no injury?

Often when we get sick, our immune system will produce extra fluid to help our body flush out toxins. This is also completely normal and should go away after the illness resolves. Sometimes when we get sick our lymph nodes get bigger and as a result produce extra fluid. If there is illness to any of our major (heart, kidney, liver, lungs), you may notice extra fluid collecting in the body or the limbs. It is important to make sure your doctor is aware so he or she can provide your child with proper help.

What is a compression garment? Can a compression garment help?

A compression garment is a tight stocking or sleeve that provides gentle compression to the area that has increased fluid. The compression helps provide a gentle squeeze to the vessels so the body can re-absorb the extra fluid. Our body is pretty smart and normally manages the fluid itself with pumps and contractions. The lymphatic, venous and arterial vessels in our bodies are very close to our muscles. Each time you move a muscle, the contraction of the muscle helps pump fluid back to our heart.

A good example is our calf muscle, a big muscle that helps move fluid from your legs and feet back up to the heart. As children run and play the muscle helps pump fluid and prevents the fluid from pooling. If your child is in the hospital and not moving very often you may notice swelling. The simple act of doing more moving or going for a walk may help. If there is a medical issue causing the swelling, the doctor may prescribe compression garments to help keep the area down in size while the medical issue resolves. If your child is outside the hospital and still has swelling, do not worry; you can buy compression garments over the counter.

There are many different types and styles of compression garments; I will try to break them down to make the process of buying a little bit easier.

There are two categories of compression garments: non-medical-grade and medical-grade. Most compression garments that can be bought at the store or off the Internet have on average 8-18 mmHg, depending on the brand. These will often feel like a thick, heavy elastic sock or sleeve for the arm. This level of compression is completely appropriate for mild swelling, or swelling that comes and goes. These garments often come in fun colors or patterns and can be worn to look like regular socks. Unfortunately, it may be hard to find pediatric sizes because most companies make compression socks for adults who suffer from mild swelling after traveling on an airplane or being on their feet all day.

The medical-grade compression garments are anything over 20mmHg and are separated into three classes:

You should not obtain anything medical-grade for your child without obtaining a prescription or speaking to a physician first. Children’s skin is often thinner than adults, and the wrong level of compression can cause more problems if the appropriate class is not prescribed.

Medical-grade garments are typically made for patients with specific medical problems such as lymphedema, vascular insufficiency, or a vascular malformation. The appropriate class and type of compression garment will be prescribed by a professional once you have a diagnosis. Although you can buy medical-grade garments at the stores or off the internet, you should still seek advice from a professional because this may not be the best option depending on the diagnosis. A compression-garment specialist will be able to tell you if your child can wear an elastic compression garment, or if your child will need a custom-made garment that is not elastic.

Always contact your physician for advice on your child’s health issues. This article is provided as a reference and does not replace medical care under the supervision of a professional practitioner.