Lymph Nodes Step-by-Step
Lymph nodes are small, bean-shaped glands that are part of your child's immune system. They help fight infections by filtering harmful substances and housing white blood cells that attack pathogens. Lymph nodes are located throughout the body, with clusters commonly found in the neck, under the chin, in the armpits, and groin. Since children are smaller and developing, their nodes often appear more prominent. Lymph nodes often change in size or swell in response to infections or inflammation, which is a normal immune response. This swelling is known as lymphadenopathy. Common causes include viral infections (like colds), bacterial infections, skin conditions (like eczema), and, rarely, more serious conditions.
how to check your child’s lymph nodes
If you notice a larger lymph node, use the pads of your fingers to gently feel it. Here’s what to look for:
size: measure it with a small ruler if you can. Normal lymph nodes are usually 1-2 cm in diameter.
pain: see if it’s tender or painful when you touch it. Lymph nodes that are painful are often reacting to local inflammation or infection or can sometimes be infected themselves.
consistency: how does it feel? Nodes that feel rubbery (like small rubber balls) are generally reassuring; ones that feel like a hard metal ball should be evaluated.
mobility: is it moving around under your fingers when you touch it, or is it fixed in position? Lymph nodes that are mobile are reassuring, while those that are fixed in place or matted together need more evaluation.
location: this is important. Lymph nodes in the head and neck are very common in kids. Feel under their ears, jaw, down the front of their neck, the back of their neck, and around the nape of their neck. You may even be able to identify a potential local source (like runny nose, new teeth, ears, ticks in the hair, etc.). If you see a lymph node above the clavicle (supraclavicular), on the inside of the elbow (epitrochlear), or on the back of the knee (popliteal), call your doctor for prompt evaluation - it is unusual to have nodes enlarged in these areas, so we always want to evaluate further.
number: do you see just one lymph node (one or a few in a chain are often a local response) or multiple across the whole body (can signal something bigger going on in the body).
what we think about
There are many reasons for enlarged lymph nodes - here are the common things that we consider when we’re thinking through them.
Reactive Lymphadenopathy: The most common cause in children, occurring when lymph nodes react to infections like colds, influenza, or strep throat. Nodes are typically tender, soft, mobile, and may enlarge rapidly but resolve as the infection clears.
Lymphadenitis: An infection of the lymph node itself, often caused by bacteria like Staphylococcus aureus or Streptococcus pyogenes. Nodes are red, warm, swollen, and very tender, sometimes with pus formation.
Less Common Causes: Although rare, conditions like lymphoma or leukemia can cause hard, non-tender, fixed nodes that grow over time, often with symptoms like unexplained fevers, night sweats, or weight loss. Autoimmune diseases and chronic skin conditions can also lead to lymph node swelling
what to do
When you bring your child to a healthcare provider for swollen lymph nodes, the approach will vary based on the child’s history, physical examination, and any associated symptoms:
Watchful Waiting: If the lymph nodes are mildly enlarged, soft, mobile, and associated with a recent infection, your provider may recommend monitoring over time. This involves tracking the size, tenderness, and any new symptoms. Many reactive lymph nodes shrink on their own as the infection resolves - this may take up to 6-8 weeks at times.
Medications: Over-the-counter medications like Motrin (ibuprofen) can help reduce pain and inflammation, especially if the lymph nodes are tender. Motrin can also help manage fever if present.
Ultrasound: If the lymph node is unusually large, hard, or has suspicious characteristics, your provider might order an ultrasound. This imaging test helps evaluate the internal structure of the lymph node, distinguishing between solid and fluid-filled areas, and identifying signs of abscesses or abnormal tissue.
Laboratory Tests: Blood tests can provide additional clues:
Complete Blood Count (CBC): This test checks for signs of infection, anemia, or abnormal white blood cell counts, which can point to underlying conditions like leukemia.
C-Reactive Protein (CRP): CRP measures inflammation levels in the body, which can help differentiate between viral and bacterial infections.
Infectious Disease Markers: Some infections can cause enlarged nodes, like EBV, CMV, cat scratch, tuberculosis, etc.
Further Evaluation: Depending on the results, your provider may recommend:
Referral to a specialist (e.g., ear, nose, and throat, surgeons, infectious disease, hematology/oncology) for persistent or concerning findings depending on what initial labs and imaging above show.
Biopsy: In rare cases, a small sample of the lymph node may be taken to rule out malignancy or specific infections.
when to seek help
Rapidly growing, hard, or fixed nodes
Accompanied by fever, night sweats, or weight loss
Red, warm, and very tender nodes
pain or discomfort
Nodes larger than 2 cm persisting beyond a few weeks
Nodes in newborns less than 3 months old
with any questions or concerns
and just remember…
Most swollen lymph nodes in children are due to common infections and resolve on their own. Monitoring changes, noting new symptoms, and consulting your pediatrician when in doubt can provide peace of mind. Swollen lymph nodes often indicate that your child's immune system is doing its job effectively.
Sending you a big hug,
Anjuli
Disclaimer: For educational purposes only and should not be regarded as medical advice or replace the advice of your physician and medical care team.