Lymphadenopathy - cervical lymph nodes

Children with palpable cervical lymph nodes

Key Messages:

• Palpable cervical lymph nodes (CLNs) in children are in most cases not pathological
• Small palpable CLNs (<1 cm) are generally considered physiological and can remain for several months without concern.
• Persistent CLNs less than 2cm don’t require referral as some never completely disappear - if fluctuating with intercurrent illness and not progressively enlarging we can be reassured
• Neck ultrasound have should not be used routinely to screen healthy children with palpable CLNs

What to Do:

• conduct a comprehensive history and clinical assessment - this is important to look for out infectious causes (ask about travel history and TB contacts) and identify any signs pointing towards malignancy.
• A short history of illness with localised warm, red, tender lymph node is in keeping with lymphadenitis - if small and the child is systematically well a 10 day course of co-amoxiclav with interval review can be considered. Refer acutely if not or concerned.
• Look for periodontal disease which can cause lymphadenopathy/lymphadenitis and examine the scalp (cradle cap/eczema)

When to Refer:

• If a child has CLNs larger than 2 cm that persist for over 6 weeks, they should be referred to secondary care

Lymphadenopathy (any site)and suspected malignancy

• Below is 2021 guidance from Childrens Cancer and Leukaemia group

Patient Information

Lymphadenitis

Lymphadenitis :: Healthier Together

References

Ruffle A, Beattie G, Prasai A, et alFifteen-minute consultation: A structured approach to the child with palpable cervical lymph nodesArchives of Disease in Childhood - Education and Practice 2023;108:326-329.

Thanks to Dr Piccinelli for review and contribution