Splenomegaly in children causes symptoms and is it a cause for concern

The spleen is located in the upper left part of the abdomen, just beneath the rib cage and towards the back. It is an important part of the lymphatic system responsible for protecting the body from infections. The spleen produces white blood cells that attack bacteria, cleans the body of damaged cells and foreign substances, and also helps maintain the balance of red blood cells and platelets.Normally, the spleen is about the size of a fist, but in some children, it can become enlarged due to diseases or infections. This makes mothers often ask: Is an enlarged spleen in children dangerous?In this article, we will answer this question and explain everything about the causes, symptoms, diagnostic methods, and the latest treatment options.

1. Is an enlarged spleen in children dangerous?
In some cases, it can be dangerous, especially if caused by a chronic disease or if not treated promptly. But with early diagnosis and regular follow-up with the doctor, the condition can be controlled and complications prevented.

2. Can an enlarged spleen go away on its own?
Yes, in certain cases like viral infections (such as infectious mononucleosis), the enlargement can disappear after the child recovers. But if the cause is a blood or liver problem, treatment and regular follow-up are needed.

3. Does an enlarged spleen affect the child’s appetite?
Yes, very much so. The enlarged spleen can press on the stomach, making the child feel full quickly or lose appetite, which can affect their weight and growth if it continues.

4. Can a child live without a spleen?
Yes, a child can live without a spleen, but they must get certain vaccinations and take good care of their health because they become more prone to infections. This requires continuous medical monitoring.

5. Does an enlarged spleen cause fever in children?
If the enlargement is due to an infection or inflammation, like brucellosis or viral infections, the child may experience frequent fevers and elevated body temperature.

6. How can I tell if my child has an enlarged spleen?
The main signs include:

Pain or swelling in the upper left side of the abdomen
Feeling full quickly
Persistent fatigue
But a precise diagnosis is made through a doctor’s examination, blood tests, and ultrasound or imaging of the abdomen.

7. Does an enlarged spleen cause gas or bloating?
It’s not a primary symptom, but if the spleen is very large, it may press on the stomach or intestines, causing some gas or bloating indirectly.

8. Can an enlarged spleen cause shortness of breath?
Sometimes, especially if the spleen is very large and presses on the diaphragm, which may make the child feel difficulty or tightness in breathing.

9. What is the appropriate treatment for an enlarged spleen in children?
Treatment varies depending on the cause and may include:

Antibiotics if there is an infection
Medications for blood or liver diseases
In severe or chronic cases, surgical removal of the spleen may be needed, under strict medical supervision.

10. Does an enlarged spleen make the belly look bigger?
Yes, if the enlargement is severe, the child’s belly may appear swollen or larger than normal, which is more noticeable in thin or young children.

11. Does an enlarged spleen cause pain?
Usually, there is mild pain or a feeling of pressure on the left side of the abdomen. Sometimes the pain can extend to the shoulder or back, especially with movement or eating.

12. Does a child with an enlarged spleen need to sleep on a specific side?
There is no specific sleeping position required. But if the child feels pain on one side, they will usually choose the position that relieves it naturally. The important thing is to sleep calmly and comfortably.

13. Can an enlarged spleen be hereditary?
Yes, in hereditary diseases like storage disorders or thalassemia (Mediterranean anemia), chronic spleen enlargement can occur from a young age.

14. Can we prevent spleen enlargement from the start?
Preventing the cause itself is not always easy, but early detection of infections or blood and liver problems helps reduce the risk of enlargement or related complications.

15. Does an enlarged spleen affect the child’s school performance or studying?
It can, if the child suffers from fatigue, anemia, or frequent infections. This affects their concentration and activity at school, requiring psychological and health support from family and school.

16. Can a child with an enlarged spleen move or play normally?
If the condition is mild, the child can move normally. But if the spleen is large or at risk of rupture, the child should avoid rough play or sports involving abdominal impacts, like karate or football.

17. Are there foods forbidden for children with an enlarged spleen?
There are no directly forbidden foods, but it is important that:

Nutrition is healthy and balanced
Food supports immunity and blood health
Avoid foods that may cause infection or strain the digestive system (like raw or undercooked food)

19. When do we resort to spleen removal (splenectomy)?
If the spleen causes major problems like:

Excessive destruction of blood cells
Repeated complications
Or if it ruptures due to injury
Then the doctor may decide to remove it as a last-resort treatment.

20. Can a child live normally after spleen removal?
Yes, a child can live normally, but after surgery they must:

Receive certain vaccinations against infections
Have regular health check-ups
Sometimes take preventive antibiotics according to the doctor’s instructions.

What is spleen removal (splenectomy)?
Splenectomy is a surgical procedure to remove the spleen, a small organ located in the upper left part of the abdomen. The spleen’s function is very important because it:

Filters damaged blood cells
Helps the body fight infections by producing white blood cells

In some medical cases, the spleen must be removed through this surgery, especially when problems cannot be solved with regular treatment.

Despite the spleen’s importance, children can live normally without it, but they need close medical follow-up and precautions to strengthen their immunity.

Is enlarged spleen in children dangerous?

In most cases, an enlarged spleen in children is not dangerous and results from increased spleen activity or simple blood issues like elevated platelets.

In these cases, the child may have no symptoms, and the enlarged spleen is often discovered incidentally during routine check-ups.

However, sometimes the enlargement is due to serious diseases requiring urgent treatment, or if the spleen is very large, it may expose the child to risks like internal bleeding if they get hit or injured.

Symptoms of enlargement may include pain in the upper left side of the abdomen, but only a doctor can determine the severity based on tests.

Spleen size in children

The spleen in children is smaller than in adults, and its size changes as the child grows.

Spleen during growth stages:

In infants: the spleen length is about 5 centimeters approximately.
In older children and teenagers: the spleen size gradually increases until it approaches adult size.

Effect of age on spleen size:
Over time, especially in older adults, the spleen size may decrease slightly due to natural body changes.

But if a significant change in spleen size is noticed, especially enlargement (splenomegaly), it may indicate underlying health problems that need monitoring and treatment.

Why is spleen removal performed in children?

Splenectomy becomes necessary in some medical conditions when the spleen causes health problems for the child. The main reasons include:

Blood disorders:

Sickle cell anemia: In this condition, blood cells are abnormal and get trapped in the spleen, damaging it.
Thalassemia: A genetic disease causing rapid destruction of red blood cells, affecting spleen function.

Spleen rupture:
If the child suffers a strong injury or accident, the spleen may rupture causing internal bleeding, requiring immediate surgical removal.
Chronic spleen diseases:
Such as chronic inflammation of the spleen causing enlargement and loss of normal function.
Tumors or abnormal enlargement:
In some cases, abnormal growths or tumors develop in the spleen, requiring removal to protect the child’s health.

When does a child need spleen removal?

The surgery becomes necessary if the child has:

Pain or swelling in the upper left side of the abdomen (a sign of an enlarged spleen)
Easy bleeding or bruising due to poor spleen function
Repeated infections because the spleen cannot fight infections well
General fatigue or weakness caused by blood cell problems

Risks of spleen removal

Although the surgery is generally safe, there are some risks to be aware of:

Increased risk of infections: After spleen removal, the body is weaker against certain infections, so it’s very important for the child to keep up with vaccinations and be under medical care.
Wound healing problems: Especially if the child has immune disorders or other health issues.
Fluid accumulation in the abdomen: This can sometimes happen after surgery.
Bowel obstruction: Rare but possible if the surgery was complicated.

How is spleen removal performed?

There are two main surgical methods:

Laparoscopic Splenectomy:
This is a modern, less painful method done through small incisions in the abdomen, and it requires a shorter recovery time.
Open Splenectomy:
This is the traditional surgical method with a larger incision, usually used in emergencies or major injuries.

Causes of enlarged spleen in children

Splenomegaly in children can occur for many reasons, the main ones include:

Blood disorders:

Hemolytic anemia: when blood cells break down too quickly.
Sickle cell anemia: a genetic disease where blood cells have abnormal shapes and get trapped in the spleen.
Hereditary spherocytosis: where red blood cells are abnormally shaped.
Thalassemia: a genetic disease causing rapid destruction of red blood cells.

Reduced blood flow to the spleen:
When blood does not drain properly from the spleen’s vein, congestion and enlargement may occur, caused by:

Congestive heart failure.
Liver diseases and portal hypertension.

Cancers:
Various blood cancers, including:

Leukemia (acute lymphoblastic leukemia and acute myeloid leukemia).
Hodgkin lymphoma (cancer of the lymph nodes).

Metabolic diseases:
Rare genetic disorders affecting the spleen, such as:

Gaucher disease.
Niemann-Pick disease.
Childhood sarcoidosis.

Infections:
Some infections can cause spleen enlargement, including:

Tuberculosis.
Malaria.
HIV (human immunodeficiency virus).
Hepatitis B or C viruses.
Cytomegalovirus.
Toxoplasmosis (cat parasite infection).

Symptoms of enlarged spleen in children

If your child has an enlarged spleen, you may notice these symptoms:

Pain or fullness in the upper left abdomen, often worse after eating.
Abdominal swelling: the spleen may be visible as a lump under the skin.
Loss of appetite or feeling full quickly because the enlarged spleen presses on the stomach.
Fatigue and general weakness due to poor blood filtering.
Pale or yellowish skin due to anemia.
Persistent or recurrent fever if caused by viral or bacterial infection.
Easy bleeding or bruising because the spleen may break down platelets.
Unexplained weight loss.
Frequent infections, since the spleen plays a major role in immunity.
Difficulty breathing if the spleen is very enlarged and presses on the diaphragm.
Nausea or vomiting due to stomach pressure.
Pain in the left shoulder or back, as pain can radiate from the abdomen.
Swelling of feet or body in advanced cases.
Changes in the child’s behavior, such as irritability or excessive sleep without obvious reasons.

⚠️ Complications of Enlarged Spleen (Splenomegaly) in Children

An enlarged spleen is not just a minor problem; it can lead to serious complications that we need to be aware of, including:

1. Ruptured Spleen

This is one of the most dangerous complications and often happens if the child experiences a strong impact or blow to the abdomen.
Rupture causes severe internal bleeding that can threaten the child’s life if not treated promptly.

2. Anemia

An enlarged spleen breaks down red blood cells faster than normal, causing the child to suffer from severe anemia, which results in constant fatigue and weakness.

3. Thrombocytopenia (Low Platelet Count)

When platelet count decreases, blood clotting is impaired, so the child may develop bruises or bleeding even from minor cuts.

4. Leukopenia (Low White Blood Cell Count)

This weakens the child’s immune system, making them more susceptible to frequent infections.

5. Pressure on Nearby Organs

A swollen spleen may press on the stomach or lungs, affecting the child's ability to eat and breathe normally.

6. Need for Splenectomy (Surgical Removal of the Spleen)

If the condition worsens or no other treatments work, the doctor might decide to surgically remove the spleen.

7. Chronic Fatigue and Growth Delay

Due to ongoing anemia, the child feels constant tiredness, and their physical and mental growth may be negatively affected.

8. Digestive and Nutritional Problems

Pressure on the stomach causes early satiety, reducing the child’s appetite and possibly leading to weight loss.

9. Abdominal Shape Changes

The belly might appear bloated or show a noticeable lump on the left side, which can worry parents.

10. Liver and Spleen Dysfunction Together

In some genetic diseases, both the liver and spleen functions are impaired, affecting the body's ability to cleanse the blood and remove toxins.

11. Increased Risk of Infection After Splenectomy

After spleen removal, the child is more vulnerable to certain serious infections and requires vaccinations and ongoing medical follow-up to protect against these risks.

Does an Enlarged Spleen Cause Gas in Children?

When the spleen enlarges, it occupies more space in the abdomen and presses on the stomach and intestines, which may cause:

Slow intestinal movement
A feeling of bloating and fullness
Increased gas in the abdomen

However, gas is not a primary symptom of an enlarged spleen. If the child has gas, other causes are more likely, such as:

Certain foods
Lactose intolerance
Digestive issues like infections

When to Suspect the Enlarged Spleen is Causing Gas in Children?

If the child has gas and abdominal bloating along with other symptoms, be cautious, especially if there are signs like:

Pain in the upper left part of the abdomen
Pale face or persistent tiredness
Loss of appetite and refusal to eat
Frequent fever
Noticeable abdominal swelling without an obvious cause

If these symptoms appear together with gas, see a pediatrician immediately for a full physical examination, blood tests, or imaging as needed.

Does Enlarged Spleen Cause Shortness of Breath in Children?

Answer: Yes, but indirectly and in certain cases.

How does an enlarged spleen cause shortness of breath?
The spleen is located in the upper left abdomen, and when it enlarges, it presses against the diaphragm—the muscle responsible for breathing.

This pressure makes it difficult for the child to take a deep breath.
The child may feel discomfort in the abdomen and chest, especially after eating, due to increased pressure on the stomach.
They may take short, rapid breaths to try to relieve discomfort, which can look like shortness of breath.

How is Enlarged Spleen Diagnosed in Children?

1. Clinical Examination

The doctor examines the child by:

Feeling the abdomen, especially the upper left side, to detect spleen enlargement.
If the spleen is enlarged, a mass can be felt under the ribs.
Listening to symptoms like fatigue, abdominal pain, and loss of appetite.

2. Laboratory Tests

Complete blood count (CBC): detects anemia, low platelets, or low white blood cells.
Liver and spleen function tests: to assess organ health.
Epstein-Barr virus (EBV) or other infection tests.
Tests for infections or genetic diseases (e.g., toxoplasmosis, malaria, thalassemia) as needed.

3. Imaging

Ultrasound (Sonography): the easiest and most accurate way to check spleen size and detect fluid accumulation.
CT scan or MRI: used in complex cases or to rule out tumors.

4. Additional Tests if Needed

Bone marrow biopsy if blood disorders like leukemia are suspected.
Immune system tests for chronic autoimmune diseases.
Genetic testing if there is a family history of hereditary diseases.

Treatment of Enlarged Spleen in Children

1. Treating the Underlying Cause

The spleen itself is not treated directly; the focus is on treating the cause of enlargement:

Viral infections (e.g., Epstein-Barr virus):
Usually supportive care—complete rest, plenty of fluids, and fever/pain relievers.
Improvement occurs over time without surgery.
Bacterial infections:
Appropriate antibiotics are prescribed based on the bacteria type, clearing infection and reducing spleen size.
Chronic blood diseases (e.g., sickle cell anemia, thalassemia):
Special treatments such as regular blood transfusions, medications to reduce crises, or surgery in some cases.
Autoimmune or storage diseases:
Treatment depends on the specific disease and doctor recommendations.

Medications Used to Treat the Causes of Enlarged Spleen

1. For Bacterial Infections

Common antibiotics include:

Amoxicillin
Cefixime
Azithromycin

The doctor determines the right drug and dose.

2. For Viral Infections

(e.g., EBV, CMV)

Most cases don’t require antiviral drugs.
Fever can be controlled with paracetamol.
Pain and fever relief with ibuprofen, but liver and kidney function must be checked first.
In some special cases, antiviral drugs like acyclovir may be used.

3. For Chronic Blood Diseases

Folic acid to stimulate red blood cell production.
Hydroxyurea for sickle cell anemia to reduce crises.
Regular blood transfusions.
Nutritional supplements as needed.

Dietary and Supportive Treatment for Enlarged Spleen in Children

4. For Autoimmune or Chronic Inflammation

Doctors may prescribe:

Corticosteroids (e.g., Prednisolone) to reduce inflammation.
Immunosuppressants (e.g., Methotrexate) in some cases.

5. For Liver Problems or Portal Hypertension

Diuretics like furosemide to reduce fluid buildup.
Drugs to improve liver function.
Beta blockers sometimes to lower portal vein pressure.

6. Regular Follow-up

Monitoring spleen size via ultrasound and physical exams.
Regular blood tests to track blood cells status.

7. Rest and Injury Prevention

Avoid contact sports or activities that risk abdominal trauma.
Ensure rest and avoid strenuous exertion until improvement.

8. Surgery (Splenectomy)

Rarely, when the spleen is very large or complications like rupture occur, removal may be necessary.
After surgery, special vaccinations and medical follow-up are essential.

Important Nutritional Advice for Children with Enlarged Spleen

1. Iron-Rich Foods

Iron helps compensate for low red blood cells:

Liver
Spinach
Lentils
Moderate amounts of red meat
Whole grains

Tip: Give vitamin C (e.g., orange juice) with meals to improve iron absorption.

2. Immunity-Boosting Foods

Because immunity is weakened:

Citrus fruits: oranges, lemons, kiwis
Leafy greens: arugula, lettuce, broccoli
Yogurt and fermented dairy (probiotics help digestion and immunity)
Natural honey (if age-appropriate and doctor-approved)

3. Avoid Fatty and Processed Foods

Fast food and fried foods strain the liver and spleen.
Limit sugars and artificial sweets.
Avoid carbonated drinks.

4. Drink Plenty of Water

Water helps detoxify and maintain healthy blood.

5. Light, Easy-to-Digest Foods

If the child complains of abdominal pain or gas:

Vegetable soups
Boiled potatoes
Plain bread or light toast
White rice or simple pasta

⚠️ Important Notes

Do not give any supplements without doctor consultation.
If the child is on chronic medication or has blood diseases, a nutritionist should customize their diet.
Regular follow-up is essential to monitor appetite, weight, and any new changes.

Which Specialist Treats Enlarged Spleen in Children?

Pediatrician: The primary doctor diagnosing and treating most childhood illnesses, including spleen enlargement.
Pediatric Hematologist: For spleen enlargement linked to blood diseases like anemia or leukemia.
Pediatric Gastroenterologist: For liver or digestive system-related issues.
Immunologist: If enlargement is caused by immune system disorders.