RHC for Health Professionals
- Persistent lethargy
- Persistent unexplained fever
- Unexplained weight loss
- Night sweats
- Unexplained bruising, bleeding or petechiae
Cervical Lymphadenopathy: Advice for referrers
Warning
Cervical lymphadenopathy is extremely common in young children, with palpable lymph nodes present in 45-57% children at any one time. The most common reason is a benign response to a self- limiting infection. However it can due to more serious conditions and a thorough history and examination should be taken.
- Characteristics:
- Size and distribution of enlarged nodes
- Duration of lymphadenopathy
- Rapidity of change in size of lymph nodes
- Are the lymph nodes painful?
- Any overlying skin changes?
- Are other nodes involved, supraclavicular, axillary or inguinal?
- Other conditions:
- History of recent upper respiratory tract infection, dental problems, mouth ulcers, skin infections, chronic skin condition such as eczema
- Constitutional symptoms:
- Weight loss - how much and over what time period?
- Night sweats
- Bleeding or easy bruising
- Other issues:
- History of foreign travel
- Immunisation history
- Any pets in the household?
Focused examination of lymph nodes:
- Is the node(s) fixed or mobile?
- Is the node(s) tender?
- Any associated skin changes?
- Unilateral or bilateral
- Single or multiple
- Assess the distribution – are the lymph nodes only in the cervical region or also in axillary or inguinal regions?
- Is the node(s) red, tender, or fluctuant, suggesting an infection or abscess?
- Is the node(s) hard, matted together or non-mobile – more suggestive of non-benign lymphadenopathy?
- Note – supraclavicular nodes are not usually a sign of recent infection and can be more suggestive of malignancy
General examination:
- General appearance – is the child well or unwell?
- Growth including weight and height
- Presence of hepatosplenomegaly?
- ENT examination findings
- Skin for evidence of eczema, impetigo, cellulitis, petechiae
We do not recommend any routine investigations in primary care.
Nil specific.
- King D, Ramachandra J, Yeomanson D. Lymphadenopathy in children: refer or reassure? Archives of Disease in Childhood - Education and Practice 2014;99:101-110
- Kubba H. A child with cervical lymphadenopathy. Clinical Otolarynology, 31, 433-434