Lymphadenopathy

Advice for Parents and Carers

  • 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.

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

What do I do if I am worried my child has sepsis?

  • Get advice from a doctor or healthcare professional or ring 111
  • Your child will need to be examined and have a set of vital signs measured (temperature, heart rate and blood pressure)

Remember most children with fevers or who are unwell, don’t have sepsis

Tests

There is no one test to see if your child has sepsis.  The tests to look for the infection will vary depending on their age, symptoms and medical history. They can include blood tests, urine tests, chest X-rays and occasionally lumbar puncture (needle in the back to collect spinal fluid)

Your healthcare team should talk to you about any tests or procedures they would like to do, what will happen and what they are for

Remember

If you're worried that your child or baby is not getting better, still seems unwell or is not themselves, you should talk to a doctor or other healthcare professional. It is important to ask for advice if you're worried, even if you have already seen a doctor, are still having treatment, or are back home. This is because the problems caused by sepsis can come on very quickly, and you may need more (or different) treatment. You should always feel that you can ask questions at any point in your care.

Symptoms of sepsis - NHS (www.nhs.uk)

Sepsis: what to look out for and what care you should expect (nice.org.uk)

Paediatric-Leaflet.pdf (sepsistrust.org)​​​​​

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

  • 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

Feedback Question: Has the advice on this page helped you with a healthcare decision?