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.
Cervical Lymphadenopathy: Advice for referrers
exp date isn't null, but text field is
Red Flags
• Persistent lethargy
• Persistent unexplained fever
• Unexplained weight loss
• Night sweats
• Unexplained bruising, bleeding or petechiae
Who NOT to refer
- Children with <1cm lymph nodes in the absence of red flag symptoms
- Reactive lymphadenopathy is common and may last indefinitely. Please reassure parents / carers
Who TO refer
- Lymph nodes persistent for more than 6 weeks and >2cm in size
- Lymph nodes in supraclavicular / axillary area
- Lymph nodes which are increasing in size
- Any red flag symptoms
Information to Include - History
- 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?
Information to Include - Examination
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
Suggestions for management while waiting for outpatient appointment
We do not recommend any routine investigations in primary care.
Useful resources for Parents
Nil specific
Useful resources for Health Professionals
- 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
Editorial Information
Last reviewed: 01 August 2022
Next review: 09 August 2025
Author(s): Claire Gilmore, Clinical Fellow; Lynn Macleod, Consultant Medical Paediatrics