Should Your Child See a Doctor?

Lymph Nodes – Swollen


  • Increased size of a lymph node in the neck, armpit or groin
  • Usually larger than the corresponding node on the other side of the body
  • Normal nodes are usually less than ½ inch (12 mm) across (size of pea or baked bean)


  • Neck Nodes. The cervical neck nodes are most commonly involved. This is because of the many respiratory infections that occur during childhood.
  • Viral Throat Infection. This is the most common cause of swollen nodes in the neck. The swollen nodes are usually ½ to 1 inch 12 -25 mm across. They are the same on each side.
  • Bacterial Throat Infection. A swollen node with a bacterial throat infection is usually just on one side. It can be quite large over 1 inch 25 mm across. This is about the size of a quarter. Most often, it's the node that drains the tonsil.
  • Tooth Decay or Abscess. This causes a swollen, tender node under the jawbone. Only one node is involved. The lower face may also be swollen on that side.
  • Armpit Swollen Nodes. Causes include skin infections such as impetigo. A rash such as poison ivy can do the same.
  • Groin Swollen Nodes. Causes include skin infections such as athlete's foot. A retained foreign object such as a sliver can be the cause.
  • Widespread Swollen Nodes. Swollen nodes everywhere suggest an infection spread in the blood. An example is infectious mono. Widespread rashes such as eczema can also cause all the nodes to enlarge.
  • Normal Nodes. Lymph nodes can always be felt in the neck and groin. They are about the size of a bean. They never go away.

Return to School  

  • Swollen lymph nodes alone are not contagious. If the swollen nodes are associated with a cold, sore throat or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.

When to Call Your Doctor for Lymph Nodes - Swollen

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Node in the neck causes difficulty with breathing, swallowing or drinking
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Overlying skin is red
  • Rapid increase in size of node over several hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • 1 or more inches (2.5 cm or more) in size by measurement
  • Very tender to the touch
  • Interferes with moving the neck, arm or leg
  • Fever present for more than 3 days

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • In the neck and also has a sore throat
  • Large nodes at multiple locations
  • Cause of the swollen node is unknown
  • Age under 1 month old
  • Large node persists over 1 month

Parent Care at Home If

  • Mildly swollen lymph node and you don't think your child needs to be seen

Home Care Advice for Swollen Lymph Nodes

  1. Reassurance for Normal Nodes: If you have discovered a pea-sized or bean-sized node (smaller than ½ inch or 12 mm), this is a normal lymph node. Don't look for lymph nodes, because you can always find some (especially in the neck and groin).
  2. Reassurance for Swollen Nodes from a Viral Infection: Viral throat infections and colds can cause lymph nodes in the neck to double in size. Slight enlargement and mild tenderness means the lymph node is fighting the infection and doing a good job.
  3. Fever or Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen as needed for fever above 102° F (39° C) or pain. Otherwise no treatment is needed.
  4. Avoid Squeezing: Don't squeeze lymph nodes because it may keep them from shrinking back to normal size. Tell your child not to fidget with them.
  5. Contagiousness: Swollen lymph nodes alone are not contagious. If the swollen nodes are associated with a cold, sore throat or other infection, your child can return to school after the fever is gone and your child feels well enough to participate in normal activities.
  6. Expected Course: After the infection is gone, the nodes slowly return to normal size over 2 to 4 weeks. However, they won't ever completely disappear.
  7. Call Your Doctor If:
    • Node enlarges to over 1 inch (2.5 cm) in size
    • Node over ½ inch (12 mm) persists over 1 month
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


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  7. Margileth AM. Sorting out the causes of lymphadenopathy. Contemp Pediatr. 1995; 12 (1):23-40.
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This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/30/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.