Lymphadenopathy

Advice for professionals

INFORMATION FOR PROFESSIONALS: After you have read this page please can you provide feedback to one very quick question at the bottom of this page which will help us make sure the information you have read has helped your decision making.

Lymphadenopathy paediatric pathway. 

When should you worry?

If your child has any of the following:

  • Is pale, mottled and feels abnormally cold to touch
  • Is going blue around the lips or has pauses in their breathing (apnoeas) or has an irregular breathing pattern
  • Severe difficulty in breathing - too breathless to talk or eat/drink
  • Has a fit/seizure
  • Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
  • Develops a rash that does not disappear with pressure (see the 'Glass Test')
  • Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features) 

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
  • Continues to have a fever of 38.0°C or above for more than 5 days
  • Develops pain and redness of the lymph node
  • Lymph nodes increasing in size - bigger than a 10 pence coin
  • Unexplained bruising
  • Losing weight

You need to contact a doctor or nurse today.

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If your child:

  • Continues to have enlarged lymph nodes that are slowly improving but he/she is otherwise healthy
  • Small lymph nodes may persist for years

Self care

Continue providing your child’s care at home. If you are still concerned about your child, contact NHS 111 – dial 111 or for children aged 5 years and above visit 111.nhs.uk

This guidance has been reviewed and adapted by healthcare professionals across North East and North Cumbria with consent from the Hampshire development groups.

  • Use painkillers such as ibuprofen and paracetamol to keep your child comfortable - please read and follow the instructions on the medicine container.

  • It is normal for lymph nodes in your child's neck to be enlarged when they have an infection such as a sore throat. This is your child's normal response to fighting common infections. Antibiotics are not normally required.
  • Children with severe eczema often have enlarged lymph nodes. This will improve with treatment of your child's eczema.

  • Occasionally, enlarged lymph nodes can become infected. If the lymph node is painful, red and hot, your child will need to see a healthcare professional because they may need treatment with antibiotics.
  • If your child has been prescribed antibiotics for an infection of their lymph nodes and still has a fever after 2 days, they will need to be seen again.

  • Your child should start getting better within a couple of days but their lymph nodes may take 2-4 weeks to improve. Small lymph nodes may persist for years.

LEFT: Painless enlarged lymph nodes on both sides of the neck (bilateral) associated with a sore throat - likely to improve without treatment.

RIGHT: Painful, hot swelling on left side of neck caused by an infected lymph node - requires treatment with antibiotics

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