Lymph nodes, swollen in children

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What are swollen lymph nodes in children?

Lymph nodes are small glands that are responsible for the “filtration” of the lymph, the tissue water. They are also part of our immune system and therefore important for the defense against infections. Lymph nodes occur in various places throughout the body; (Enlarged) lymph nodes in the neck region, in the armpit and in the groin are particularly easy to feel.

When an infection occurs, processes in the lymph nodes are activated that ensure that a pathogen is eliminated as quickly as possible. The lymph nodes swell and become palpable or even visible and painful. This is a normal process that shows that our immune system works effectively. As soon as the infection subsides, the lymph nodes become smaller again. However, this can also be delayed by a few days. Some lymph nodes scarr after severe infections and are therefore always palpable.


Swollen and painful lymph nodes are very common in children and are not a cause for concern. Many diseases, especially flu infections, lead to swelling of the lymph nodes.

Important instructions

In children, swollen lymph nodes are usually a sign of a benign disease: the lymph node is enlarged, painful, and there is an infection at the same time.

Are the lymph nodes in a certain area, e.g. B. enlarged in an armpit, this is usually the result of local acute or chronic inflammation, for example as a result of an inflamed wound.

If the lymph nodes in the neck, armpits and groin are swollen, there is usually a general infection that is often caused by viruses.

In very rare cases, other causes of swollen lymph nodes in children can also be caused by malignant diseases caused become. In Germany, for example, B. about 150 children a year from lymph gland cancer, Hodgkin’s lymphoma. So this disease is very rare. Another lymphoid cancer, non-Hodgkin-lymphoma, occurs in children, but is much more common in adults. In other tumors, adjacent lymph nodes can also be affected, which then enlarge.

Most common causes

Swollen lymph nodes in a specific area (local)

  • The cause is usually a local infection, e.g. B. in the throat or in the skin.
  • Sore throat (pharyngitis)
  • The lymph nodes in the throat are swollen.
  • The child has a cold and feels uncomfortable, but shows no other symptoms of the disease.
  • throat infection
    • The lymph nodes in the neck area are swollen.
    • The child is sick and has a high fever and difficulty swallowing.
    • Inflamed wound
      • With a heavily infected wound, swelling and inflammatory reactions often occur in the neighboring lymph nodes.
      • Skin infections, e.g. B .:
        • Wound rose (erysipelas): Affects a specific area of ​​the skin that is clearly red and swollen.
        • Bark lichen (impetigo contagiosa): resembles purulent pimples, local lymph nodes are usually considerably swollen.
        • Rash (rash)
          • The lymph nodes in children with eczema can be enlarged.
          • BCG vaccination
            • The armpit lymph nodes may swell after being vaccinated against tuberculosis.
            • General swelling of the lymph nodes

              • rubella
              • There are often enlarged and pain-sensitive lymph nodes behind the ears. This also applies to numerous other typical childhood diseases or other viral infections (e.g. herpes).
            • Bacteria and other pathogens
              • Numerous bacteria, parasites (e.g. Toxoplasma) or fungi can lead to enlarged lymph nodes as part of an infection. This includes e.g. B. very rarely also tuberculosis.
              • Pfeiffer glandular fever (mononucleosis)
                • The illness resembles a protracted tonsillitis that doesn’t get better with antibiotics.
                • Rare causes

                  • Rheumatic diseases
                  • They can lead to swollen lymph nodes in children.
                • leukemia
                  • The lymph nodes may be enlarged.
                  • The hemoglobin level is often low (the child is pale), the blood contains little white blood cells (the child is more likely to develop infections) and platelets (platelets, the child quickly gets bruises and skin bleeding). Bone pain is common.
                  • Malignant swelling of the lymph nodes (lymphoma)
                    • The most common appearance is enlarged, pain-free lymph nodes, usually in the area of ​​the neck or armpits or in several places in the body.
                    • A lymphoma can also exist without enlarged lymph nodes.
                    • Some patients experience fever, weight loss, night sweats, itching, and fatigue.
                    • Malignant tumors
                      • Malignant tumors in the testicles, muscles or bones (sarcoma) lead to an initial swelling of the lymph nodes near the tumor.
                      • What can you do yourself?

                        In most cases, swollen lymph nodes do not need to be treated. They are a sign that the body’s immune system works against infections. If the immune system successfully fights the infection, the swelling subsides on its own.

                        When should you seek medical advice??

                        In children, the lymph nodes are usually smaller than 1 cm; they are often not palpable in healthy people. Slightly enlarged lymph nodes, which can be moved a little under the skin and are sensitive to pain, are typical of an accompanying reaction to an infection. The typical regions for this are armpits, groin and neck. If the child is otherwise quite well except for a cough, runny nose or the like, you can wait a few days.

                        Lymph nodes that have swollen for a long time (a few days to weeks) should be examined by a doctor, but the cause is usually harmless. However, a more serious cause can be the underlying cause of non-painful, significantly enlarged, non-displaceable lymph nodes. Swollen lymph nodes that are palpable above the clavicle are also noticeable here.

                        Swollen lymph nodes in connection with a significantly reduced general condition or other symptoms that are not caused by a cold or another infection should also be examined promptly by a doctor.

                        If you have swollen lymph nodes associated with bleeding from the skin, very frequent infections and anemia, you should quickly see a doctor.

                        How does the doctor proceed??


                        The doctor may ask you the following questions:

                        • How quickly are the lymph nodes swollen?
                        • The lymph nodes swell quickly in infections, while the swelling progresses more slowly in malignant diseases.
                      • How long have the lymph nodes been swollen??
                        • If the lymph nodes have been swollen for a long time, the risk of serious illness increases. However, most children with swollen lymph nodes do not experience a serious illness.
                        • Are the lymph nodes sensitive to pain?
                          • Pain-sensitive lymph nodes are more common in infections than in malignant diseases.
                          • Did the swollen lymph nodes appear in connection with an infection?
                            • A clear connection with an infection speaks for a safe lymph node swelling.
                            • Was the child recently vaccinated??
                              • Different vaccines lead to local or generalized lymph node swelling.
                              • The child may have tuberculosis?
                                • This is a rare cause of persistent swollen lymph nodes in Germany, but is common in children from other countries.
                                • The child was recently prescribed new medication?
                                  • Various medications can cause swelling of the lymph nodes.
                                  • Does the child have a rash?
                                    • Rash usually arises from general infections, which also cause swollen lymph nodes.
                                    • Neurodermatitis can cause swollen lymph nodes.
                                    • If the swelling comes symmetrically, i.e. H. on both sides, in front?
                                      • Swollen lymph nodes in a general infection are usually enlarged symmetrically.
                                      • Locally swollen lymph nodes due to a local infection usually have a clear cause.
                                      • Swollen lymph nodes due to a malignant disease usually spread asymmetrically.
                                      • Physical examination

                                        The medical examination depends on the patient’s medical history. If there is a clear local cause, your doctor will carefully examine this area (e.g. the pharynx). Otherwise, a comprehensive investigation is usually not necessary.

                                        In the case of generally swollen lymph nodes with no known cause, the child is examined in detail and all organs are taken into account.

                                        Further investigations

                                        If the diagnosis is unclear, a blood test may be performed to determine hemoglobin (Hb), the number of white blood cells and platelets (platelets) and signs of inflammation (sedimentation rate and C-reactive protein).

                                        Other tests depend on the possible suspected diagnosis and may include blood tests for rapid tests in the doctor’s office or for sending to a laboratory if mononucleosis is suspected.

                                        The doctor can check the lymph nodes again after about three weeks if no clear diagnosis has been made by then.

                                        An ultrasound examination of the abdominal organs can provide further information. If it remains unclear why the lymph node swelling exists, it often makes sense to remove the lymph node and examine it in the laboratory.

                                        Transfer to a specialist or a hospital

                                        If the diagnosis is unclear, you can be referred to a specialist. Especially if the lymph node swelling persists for more than 6 weeks. This is also the case if a diagnosis has been made that needs specialist treatment (e.g. in the case of cancer).


                                        Harmless infections usually heal on their own and the lymph nodes also swell. The same applies to lymph node swelling after vaccination or as a side effect of medication (discontinue medication). Virus infections can usually not be treated with specific drugs; Rest / relaxation and antipyretic measures and means are helpful. If it is a special other infection (e.g. with bacteria) or certain other illness (see above), medication may be required.


                                        • Susanne Meinrenken, Dr. med., Bremen
                                        • Natalie Anasiewicz, doctor, Freiburg i. br.


                                        This article is based on the specialist article Lymphadenopathy in Children. Below you will find the list of references from this document.

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