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Lymph Nodes – Swollen

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Definition

  • 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)

Causes 

  • Swollen nodes with a viral infection are usually ½ to 1 inch (12–25 mm) across.
  • Swollen nodes with a bacterial infection are usually over 1 inch (25 mm) across (size of a quarter).
  • The cervical (neck) nodes are most commonly involved because of the many respiratory infections that occur during childhood.
  • Elsewhere, localized nodes are usually reacting to local skin irritation or infection.

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.

References

  1. Bamji M, et al. Palpable lymph nodes in healthy newborns and infants. Pediatrics. 1986;78:573.
  2. Carithers HA. Cat-scratch disease: an overview based on a study of 1200 patients. Am J Dis Child. 1985;139:1124-1133.
  3. Chesney PJ. Cervical adenopathy. Pediatr Rev. 1994;15:276-285.
  4. Friedmann, AM. Evaluation and management of lymphadenopathy in children. Pediatr Rev. 2008;29(2):53-60.
  5. Grossman M and Shiramizu B. Evaluation of lymph adenopathy in children. Curr Opin Pediatr. 1994;6:68-76.
  6. Kelly CS, Kelly RE Jr. Lymphadenopathy in children. Pediatr Clin North Am. 1998:45:875-888.
  7. Margileth AM. Sorting out the causes of lymphadenopathy. Contemp Pediatr. 1995; 12(1):23-40.
  8. Peters TR and Edwards KM. Cervical lymphadenopathy and adenitis. Pediatr Rev. 2000;21:399-405.

Disclaimer

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.

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