By: Mahvash Madni, MD, FAAP
Swollen glands or "lymph nodes" are a frequent concern for parents, since they're so common in children. Young children often have swollen glands because their bodies' defenses are constantly at work trying to protect them from new germs they encounter every day. In most cases, the swelling goes down once the body fights off the offending germ.
Here's what parents need to know about swollen glands in children, including what's normal and when to talk with your child's pediatrician.
What are lymph nodes & why do they swell?
Lymph nodes are part of the lymphatic system, which works with the immune system to protect the body from illness. The job of lymph nodes is to filter lymph fluid, trapping germs like viruses and bacteria and helping immune cells respond.
It is not only common but it is also expected for children, especially younger than 5 years of age, to have enlarged lymph nodes from time to time.
Younger children encounter many new germs as they grow, so their immune systems are often active. When lymph nodes are busy doing their job, they can temporarily become larger.
How long do swollen glands last in children?
Many swollen lymph nodes shrink within a few weeks, though some may take longer to return to normal size.
Where are lymph nodes located?
Lymph nodes are all over the body except for the brain and heart. There are around 600 lymph nodes everywhere in the body, including the neck, under the jaw, underarms, groin, chest and abdomen (not usually felt from the outside). The lymphatic system is connected by lymph vessels, thin tubes similar to blood vessels that carry lymph fluid instead of blood. The lymphatic system also includes the tonsils, spleen and appendix.
What is a normal lymph node size?
Lymph node size varies depending on their location and the child's age. Younger children have larger lymph nodes. Lymph nodes under the arm and in the neck are around 1 cm. The groin lymph nodes are slightly larger at 1.5 cm. The lymph nodes in the arms next to the elbow are about .5 cm.
Lymph nodes often become more noticeable when your child has:
What happens when lymph nodes are reactive?
Most swollen lymph nodes in children are called "reactive" lymph nodes. This means they are responding to an infection or inflammation nearby.
Two main things can happen to lymph nodes. They can become:
1. Reactive (non‑infected) lymph nodes
Lymph nodes get bigger and their consistency can change in reactions to an infection or inflammation in surrounding tissue
Most often seen in the neck
May be mildly tender
Usually shrink slowly over several weeks
This is the most common situation.
2. Infected lymph nodes (lymphadenitis)
Usually caused by a bacterial infection of the lymph node itself
Node may become red, warm, painful and larger
Child often has fever
May need antibiotics, and rarely drainage if treatment doesn't work
What should be done for a swollen gland?
The next step for a swollen gland is to consult with the doctor's office. They may want to examine the lymph nodes and other areas of the body. In doing so they will check for other enlarged lymph nodes or figure out where the source of infection is.
If the lymph node itself is infected, they will likely prescribe an antibiotic to start with. The infected lymph node may eventually need drainage if antibiotics do not work.
Let the child's provider know about other symptoms like cough, fevers, exposure to animals and travel.
If lymph nodes stay enlarged for longer than 4 weeks an ultrasound and bloodwork may be done. This will help to evaluate the lymph node further and look into other causes.
Are swollen lymph nodes a sign of cancer?
This is rare in children. Most swollen lymph nodes are caused by infections and are not serious.
When should parents be more concerned?
Serious causes of swollen lymph nodes in children are rare, but call your child's doctor right away if a lymph node:
Grows rapidly, or the skin over the gland turns reddish or purple
Is hard, fixed or not movable
Is located above the collarbone
Is swollen and tender for more than 5 days
Or if your child also has:
Unexplained weight loss
Ongoing fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius)
Night sweats
Easy bruising or bleeding
Extreme tiredness, lethargy or loss of appetite
Trouble breathing
Enlarged lymph nodes in multiple areas of the body
Remember
Swollen lymph nodes are a normal part of childhood and usually mean the immune system is doing exactly what it should. Most swollen glands are not dangerous and improve on their own without treatment.
In the rare case that lymph node swelling lasts a long time or there are other concerning symptoms then calling the doctor's office and seeking medical attention right away is the best thing to do.
More information
About Dr. Madni
 Mahvash Madni MD, FAAP, is a general pediatrician at St. Mary's Healthcare in Amsterdam, New York, a spokesperson for the American Academy of Pediatrics and creator/host of the Child Health Podcast "Down The Yellow Brick Road... A Journey With Your Pediatrician."
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