Swollen Glands and Lymphadenopathy in Children

All About the Causes of Swollen Glands in Children

Hispanic boy getting a checkup at doctor's office
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Children can have abnormally enlarged lymph nodes (swollen glands), also known as lymphadenopathy, for many reasons.

Just because you can feel a child's lymph nodes doesn't necessarily mean that the child has lymphadenopathy. It is not uncommon to feel some normal-sized lymph nodes in infants and toddlers, with the lymph nodes measuring less than about one cm (around 1/2 of an inch.)

How common is it for children to have swollen lymph nodes? Can lymph nodes be swollen even if a child is healthy? Where are the lymph nodes located, and what lymph nodes may be of more concern than others? What are the possible causes of enlarged lymph nodes?

Swollen Glands in Children - Should You Be Worried?

Parents often get worried when their child has swollen glands or lymph nodes.

Sometimes parents worry that swollen glands are a sign of cancer, and while they sometimes may be, they are more commonly a sign that your child has some kind of a viral or bacterial infection.

If you are worried because your healthy child has swollen glands, keep in mind that by adult standards, almost all children have "lymphadenopathy," because palpable nodes, particularly in the cervical (neck), axillary (armpit), and inguinal areas (the groin), are common in children of all ages, including babies.

Glands in the Body

Glands (lymph nodes) are located throughout our bodies. Some common glands can be found:

  • In the back of the head - occipital
  • In front of the ear - preauricular
  • Behind the ear - postauricular
  • Under the jaw - submandibular
  • Under the chin - submental
  • In the cheek area - facial
  • In the front of the neck - anterior cervical
  • In the back of the neck - posterior cervical
  • Above the collarbone - supraclavicular
  • Behind the knee - popliteal
  • In the armpit - axillary
  • Below the elbow - epitrochlear
  • In the groin area - inguinal

Certain glands, especially the supraclavicular, epitrochlear and popliteal glands are rarely swollen, even in kids, and feeling them would likely prompt your pediatrician to look for a cause.

Other glands are deeper in the body and can't usually be felt. They include the mediastinal, hilar, pelvic, mesenteric, and celiac lymph nodes. These nodes might be seen on an imaging study such as an x-ray or CT scan.

The cervical, axillary, and inguinal glands are the ones that are most commonly felt in normal children. In fact, about half of children between the ages of three and five will have swollen glands in these areas when they visit their pediatrician, whether it is for a sick visit or a good child checkup.

What Are Glands?

The glands or lymph nodes are part of the body's lymphatic system, which includes lymph vessels, the tonsils, the thymus, and the spleen.

As lymph, which includes white blood cells and other things that help us fight infections, moves from our blood to the lymph vessels, it gets filtered by our lymph glands.

That is why the lymph glands in your groin might become swollen if you have an insect bite or skin infection on your leg. It is just an immune response in the glands that are closest to the area. Similarly, a scalp infection, spanning the spectrum from head lice to ringworm, might cause swollen glands in your child's cervical or occipital glands.

Causes of Swollen Glands

Many young children have swollen glands because they have frequent infections, which lead to reactive lymph nodes – glands that become swollen as a reaction to an infection in their area of the body. possible causes of reactive lymph nodes in children include:

  • Lymphadenitis - In lymphadenitis, a lymph node itself becomes infected and becomes red, swollen, and often very tender.
  • Viral upper respiratory infections - From the common cold to influenza, viral upper respiratory infections are a very common cause of swollen cervical glands in children (and adults).
  • Strep throat - With strep throat, swollen glands in the neck occur along with a fever and sore throat. Often times white patches at the back of the throat are present as well.
  • Mono - Infectious mononucleosis is caused by the Epstein-Barr virus. It usually causes a sore throat, fever, and swollen glands in the posterior cervical lymph nodes (in contrast to strep throat which usually involves the anterior cervical lymph nodes.) These nodes lie in front of and in the back of the sternocleidomastoid muscle, the large muscle that runs up the side of your neck.
  • Cat scratch disease - Cat-scratch disease is an infection caused by the bacteria Bartonella henselae. It is transmitted by infected cats or kittens through a bite or a scratch. Infections begin a week to 12 days later with a small rash. After another week or two, tender, red, and swollen lymph nodes occur. Treatment is with antibiotics.
  • Scrofula - Scrofula is an infection of a lymph node caused by atypical mycobacteria or tuberculosis. It is characterized by painless swollen glands, most commonly in the neck.
  • Kawasaki disease - A single, swollen cervical (neck) lymph node is one of the features of Kawasaki disease, with others including fever, red eyes, swelling of the hands and feet, a rash, and red mucous membranes in the mouth, with a strawberry tongue and cracked lips.

Many other infections, from tuberculosis to HIV, can also cause swollen glands and might be suspected based on a child's symptoms and risk factors.

Lymphoma, a type of cancer, seems to be what many parents worry about when a child has a swollen gland, even though it is much less common than other causes. Parents may also be concerned about leukemia, yet swollen lymph nodes as the only sign of leukemia would be very uncommon.

One type, Hodgkin lymphoma, is rare in younger children, being more common in teenagers, who, in addition to swollen glands, typically have unexplained fever, weight loss, and night sweats. Hodgkin lymphoma is linked to a previous Epstein-Barr virus infection (mono) in around 40 percent of people, though the mechanism behind this is unclear.

Children with non-Hodgkin's lymphoma can have rapidly grown, painless lymph nodes, in addition to other symptoms like fever, weight loss, night sweats, coughing, and fatigue.

Uncommon causes of swollen lymph nodes can range from hyperthyroidism to lupus, to Kawasaki disease, and more.

What to Know About Swollen Glands

Other things for parents to know about swollen glands include that:

  • In addition to having swollen glands, pediatricians look for many other characteristics, such as the size of lymph nodes, their rate of growth, their consistency (soft, firm, or rubbery), whether redness is present, and whether there is tenderness to help figure out if they might be normal or not.
  • Other associated symptoms, such as persistent or unexplained fever (fever of unknown origin), unintentional weight loss, fatigue, and night sweats can be signs of a more serious condition causing swollen glands.
  • Lymphadenopathy may be localized (in one area) or generalized (in more than two noncontiguous areas), with generalized lymphadenopathy more likely to be caused by a systemic disease.
  • A stomach virus or other gastrointestinal infection might cause swelling and inflammation of the mesenteric glands in the abdomen, which can cause abdominal glands. In fact, swollen mesenteric glands are often found when surgery is done for a suspected appendicitis.
  • There are about 600 lymph nodes in our body.
  • In addition to your pediatrician, a pediatric ear, nose, and throat specialist or pediatric surgeon (depending on the location of the glands) can help evaluate your child with swollen glands.

When Swollen Glands Need Further Evaluation

Symptoms and signs that indicate swollen glands could be something more serious include:

  • Swollen glands which are present in more than one region of the body (generalized lymphadenopathy.)
  • Lymph nodes which are firm
  • Lymph nodes which are fixed (don't easily move around)
  • Lymph nodes that are larger than 2.5 cm (larger than one inch)
  • Lymph nodes that are non-tender
  • Lymph nodes that are rapidly growing
  • Swollen lymph nodes accompanied by symptoms such as weight loss, a daily fever, or night sweats
  • The combination of swollen lymph nodes and your gut feeling as a parent that something serious is going on - trust your intuition

How Long Do Lymph Nodes Stay Swollen?

It's important to keep in mind that swollen lymph nodes can take weeks to months to return to normal size. In addition, since younger children can average six to eight upper respiratory tract infections (daycare syndrome) each year that can trigger lymphadenopathy, it may seem like your child's lymph nodes are always enlarged.

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