Swollen lymph nodes in neck’s child. When to worry?

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Dr. Sandro Cantoni. Updated: 20 September 2021

It is common for a parent to feel a lymph node on their child’s neck that seems larger than usual. 

The majority of them ask this question: is this something serious? How do I know? 

This is the topic of this article.

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How do I know if a lymph node in my child’s neck is too big?

If the lymph node, the gland you feel, is less than 1 cm in diameter, then it is a normal lymph node; it is not enlarged. 

There is nothing to worry about. Stop thinking about it. 

If your child has an enlarged neck lymph node,  bigger than 1 cm in diameter, be careful. The following signs and symptoms may be indicative of a serious or major illness.  And you must demand a timely visit to your pediatrician. 

Remember one thing, though.

If for any reason you feel worried or agitated about this gland in the neck,  ask for a medical examination.

What are the warning signs and symptoms?

1. Your child has a lymph node above the clavicle.

This is an important sign. Often cancers such as lymphomas cause glands to appear there.

2.The lymph node gradually increases in size, becomes red, and is painful when you touch it.

It is normal for a lymph node in the neck, not to heal in a few days, but it should not increase. If the opposite happens, especially if it is red and painful, it is possible that there is an abscess.  

3. The gland is over 2 cm in size, is hard and does not move when you try to displace it gently. It is hard just like a rock.

This is a sign of a suspected cancer or another major disease 

4. The lymph node is enlarged, i.e., greater than 2 cm in size, and does not improve. 

Basically, in two weeks the lymph node does not decrease in size. 

5. The child has weight loss. Or marked fatigue.

6. High fever for several days and unwellness.

The child may have a major bacterial infection. Or some types of infections that give increased neck glands such as Kawasaki disease.

7. Fever, even low, but continuing for 15 to 20 days.

This may be a sign of a persistent or recurrent viral infection but sometimes a more serious illness.

8.Glands in the neck that do not decrease and you notice that the child begins to sweat a lot at night. Much more than he used to.

This is also one of the signs of lymphoma or other cancers. But even of some particular types of infections.

9.The child has a skin rash. Especially if he has spots that do not disappear when you press them, such as small or large hematomas. 

This can also be a sign of a cancer like leukemia. But also of some types of infections.

10. The child has difficulty swallowing and can’t eat. Has severe drooling or struggles to breathe. Or has stiffness or pain in the neck.

In this case, the problem may be an infection of the muscles or structures in the neck, a pharyngeal abscess.

11. If you feel for any reason anxious and worried.

If your child has even one of these symptoms or signs, you should call your doctor. 

If your child has swollen glands, but these do not hurt, are not hard, are mobile. And your child has a sore throat or a cold, then you can be fairly comfortable. If the child does not have any of the symptoms I have described above.

Usually, in these cases, it is better to wait and see the evolution. Because often in a few days the lymph node begins to decrease and then returns to normal in about two weeks.

It is unnecessary to do tests or ultrasound in these cases.

In case of any doubt, contact your pediatrician. If the lymph node remains enlarged, the pediatrician may prescribe an antibiotic. Or some tests, such as an ultrasound of the neck.

References. 

Michael S. Weinstock, Neha A. Patel and Lee P. Smith. Pediatric Cervical Lymphadenopathy. Pediatrics in Review September 2018, 39 (9) 433-443. 

Michael F Dulin e al. Management of Cervical Lymphadenitis in Children. Am Fam Physician. 2008 Nov 1;78(9):1097-8.


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