When Your Child Has Swollen Lymph Nodes

Swollen lymph nodes can be caused by:

• Common illnesses, such as a cold or an ear infection

• Bacterial infections, such as strep throat

• Viral infections, such as mononucleosis

• Certain rare illnesses that affect the immune system

• Lymphadenitis, which is when a lymph node itself becomes infected

• In rare cases, cancer

• The healthcare provider asks about your child’s symptoms and health history.

• A physical exam is done on your child. The provider will check the nodes in the neck, behind the ears, under the arms, and in the groin. These nodes can often be felt from outside the body when they are swollen. If the provider thinks your child may have an infection, your child may have more tests.

• Treatment for swollen lymph nodes depends on the underlying cause. In most cases, no treatment is needed.

• Medicine can be prescribed by the healthcare provider to treat an infection. Your child should take all of the medicine, even if they start feeling better.

• If lymph nodes are painful or tender, do the following at home to ease your child’s symptoms: 

  • Give your child over-the-counter medicine, such as ibuprofen or acetaminophen, to treat pain and fever. Don't give ibuprofen to an infant age 6 months or younger.

    Never give aspirin to a child or teen. It could cause a rare but serious condition called Reye syndrome. This is a rare, but very serious, disorder. It most often affects the brain and the liver.

  • Put a warm, wet cloth (compress) on any painful or sore lymph nodes.

Call the healthcare provider if your child has any of the following:

• Fever (see "Fever and children" below)

• Your child has had a seizure caused by the fever

• Painful or sore, swollen lymph nodes 

• Lymph nodes that continue to grow in size or last more than 2 weeks

• A large lymph node that is very hard or doesn't seem to move under your fingers

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.
• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.
• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.
• Rectal or forehead: 100.4°F (38°C) or higher
• Armpit: 99°F (37.2°C) or higher
• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher
• Ear (only for use over age 6 months): 102°F (38.9°C) or higher
• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age
• Temperature of 104°F (40°C) or higher in a child of any age
• A fever of ___________ as advised by the provider