Swollen Lymph Nodes In Children: Causes And When To Worry

Image: Midjourney/ MomJunction Design Team

Lymph nodes are kidney-shaped organs in the neck, under the jaw (submandibular lymph nodes), under the chin (sublingual lymph nodes), underarms or armpit (axillary lymph nodes), groin, chest, and abdomen. They are a part of the immune system and play an important role in filtering the blood and killing bacteria and viruses. Swollen lymph nodes or lymphadenopathy is common in childhood and may occur due to bacterial or viral infections, such as colds, flu, or strep throat infectionⁱA bacterial infection brought on by group A Streptococcus bacteria that cause throat irritation and inflammation (1).

Read this post to learn about the causes, symptoms, complications, diagnosis, and treatment of swollen lymph nodes in children.

Causes Of Swollen Lymph Nodes In Children

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The following are the common causes of lymphadenopathy in kids (2)(3)(4)(5):

• Respiratory infections
• Viral throat infections
• Bacterial throat infections, such as strep
• Viral infections in children, such as flu, mononucleosisⁱAlso known as kissing disease, it is a contagious infection usually associated with the Epstein-Barr virus , and chickenpoxⁱA highly contagious viral infection that causes itchy and blister-like rashes due to the varicella-zoster virus
• Tooth decay or abscess
• AbrasionsⁱCuts and scrapes on the skin that happen due to contact against a rough surface , burns, or insect bites
• Scalp infections
• Skin infections, such as eczemaⁱA condition that causes itchy, inflamed, and dry skin and impetigo in children
• Mouth sores
• Ear infections

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• Fungal infections
• Autoimmune conditions
• Some cancers, such as Hodgkin’s lymphomaⁱA type of cancer that affects the lymphatic system (a part of the immune system)
• Juvenile arthritisⁱOccurrence of persistent, chronic arthritis in children and some other joint conditions

Swollen lymph nodes that appear suddenly and are painful are usually caused by an injury. Certain medications, such as typhoid immunization and seizure drugs, such as phenytoin, can also cause swollen lymph nodes in children (6).

Quick fact

Reaction to certain seizure medicines and antibiotics may cause lymphadenopathy in children (1).

Infographic: What Causes Swelling Of Each Lymph Node In Children?

Illustration: Momjunction Design Team

Frequency And Severity Of Swollen Lymph Nodes In Children

Every child may get lymphadenopathy at some point in their life (7). A recent study suggests that about 90% of children aged four to eight years may suffer from lymphadenopathy. Most of them are benign.

According to the American Academy of Pediatrics (AAP), a pea or bean-sized (i.e., smaller than ½ inch or 12 mm) swelling is considered normal (8). However, if the lymph nodes are getting bigger, it can be a sign of infection, and the process is called lymphadenitis. It can further be subdivided into:

• Acute lymphadenitis if the enlarged lymph nodes last for about two weeks
• Subacute lymphadenitis if it is there for more than 2 weeks
• Chronic lymphadenitis if it persists for more than 6 weeks (9).

Symptoms Of Swollen Lymph Nodes In Children

The most common symptoms of swollen lymph nodes are (1)

• Lumps in the affected lymph node areas, commonly the sides or back of the neck (also known as cervical lymph nodes)
• Pain, tenderness, or soreness in the affected area
• Redness or warmth in the affected area
• Lymph nodes may be swollen several centimeters.

Depending on the underlying pathology, the following symptoms may also be seen (6):

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• Fever and chills
• Respiratory issues, such as sore throat, nasal congestion, and cough
• Decreased appetite
• Body pain
• Headache
• Fatigue
• Weight loss
• Rash
• Night sweats in children

Quick fact

Lymph nodes aren’t usually palpable in newborns. Palpable lymph nodes are usually observed between three and five years (13).

Signs You Need To See A Doctor

Monitor the persistent symptoms, and if the child develops new symptoms or complications, consult your healthcare professional for further evaluation. Contact your healthcare provider if you notice the following symptoms (1) (10):

• The child develops a ever (higher than 104° F) or a seizure accompanying it
• Painful swollen lymph nodes
• Lymph nodes that continue to grow or remain the same size beyond two weeks
• A large lymph node that is firm to touch
• Abnormal breathing sounds or the child complains of inability to breathe comfortably

Complications Of Swollen Lymph Nodes In Children

Swollen lymph nodes are the body’s natural response to infections and some diseases. However, ignoring the condition may delay the treatment of a serious underlying disease or infection (1).

While swollen lymph nodes signify a problem and are not a problem themselves, the following complications may rarely occur (3).

• May remain swollen or firm long after the infection has cleared up
• May hamper the other functions of the body
• Might break open and ooze pus

Diagnosing Swollen Lymph Nodes In Children

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The diagnosis of swollen lymph nodes begins with a physical examination of the enlarged lymph nodes’ size and location. Further, the doctor will ask the following (1) (3) (11):

• A detailed medical history of the child
• For how many days the child has been exhibiting these symptoms
• Whether the child has been around children with strep throat
• Whether the child has consumed any unusual food or beverages, especially unpasteurized dairy products
• Whether the child has been around a young cat as a cat’s scratch can cause a mild condition called cat scratch disease characterized by enlarged lymph nodes.

After examining these details, the doctor might refer the child to a specialist and prescribe some of these diagnostic tests:

1. Lab tests: A complete blood count (CBC) might be performed to check the red and white blood cells and platelets. Urine tests and tests to rule out tuberculosisⁱA disease caused by a potentially severe bacterial infection that affects the lungs might be performed.

2. Imaging tests: These include chest X-rays, CT scans, or MRIs to check for enlarged lymph nodes or other underlying conditions.

3. Lymph node biopsy: A surgeon may perform a biopsy to test the samples of the enlarged lymph nodes for different causes of enlargement. The child may be further referred to hematologists and oncologists.

Quick fact

Lymphadenopathy can affect parts of the body or the lymph nodes. The cervical (neck) lymph nodes are the most common lymphadenopathy sites (1).

Treatment For Swollen Lymph Nodes In Children

In most cases, no intervention is needed for swollen lymph nodes. When required, the treatment depends on the underlying cause. It can be done at home for mild cases, while some children may need medications to manage it. Rarely, surgical intervention may be needed (3) (11).

1. Homecare

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• Ensure plenty of rest, ample hydration, and good nutrition.
• Use cold or warm compresses to relieve pain in the tender region.
• Consider using natural remedies such as herbal teas with soothing properties or warm decaf tea with honey and lemon to help reduce inflammation.
• Give safe pain relief medications, such as acetaminophen, under the doctor’s advice. Remember, children under 19 years should not take Aspirin unless advised by a doctor, as it might put the child at risk of Reye syndrome (11). Also, Aspirin must be avoided if your child is recovering from chickenpox or flu-like symptoms (9).
• Instruct your child to not squeeze the lymph nodes (8).

2. Medications

• The child might need antibiotics for swelling caused by bacterial infections or anti-tuberculosis medicines for tuberculosis.
• The doctor might prescribe further medication based on the underlying condition.
• If the swollen lymph nodes are caused by cancer, the doctor may decide the treatment plan depending on the type and severity of the cancer. The treatment includes home care, medicines, surgery, radiation, and chemotherapy (11).

3. Surgery

• When required, surgical intervention might be suggested to remove the swollen lymph node.
• A pediatric surgeon might suggest incision and drainage for the swollen lymph nodes, depending on the cause.
• While surgery is generally safe, it might have some side effects, including blood clots, slow healing of wounds, risk of infection, and tingling sensation in the area of surgery (12).

Illustration: Swollen Lymph Nodes In Children: Causes And When To Worry

Image: Dalle E/MomJunction Design Team

Learn how to identify and manage a swollen lymph node in the neck by watching this video. Discover ways to reduce swelling and ease any discomfort it may cause.

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Reviewer Author Editor Fact Checker

Dr. Maria Katrina FlorcruzMD, DPPS

Dr. Maria Katrina Florcruz is a board-certified pediatrician and a Diplomate of the Philippine Pediatric Society with over 14 years of experience. She is an active consultant at Diliman Doctors Hospital and a visiting consultant at The Medical City and Capitol Medical Center.

Read full bio of Dr. Maria Katrina Florcruz

Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

Read full bio of Dr. Ritika Shah

Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Vidya TadapatriMSc (Biotechnology)

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over five years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology.

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