Swollen Lymph Nodes: Normal, infection or malignancy?

Dr. Greene, our 7 month old daughter Elise has had swollen lymph glands in the back of her neck and head for about 3 months. They said that she could be getting over an infection (she has only been sick once and that was last week). Well, they have not gotten any smaller, and her hemoglobin was 11.3. The doctors think it is nothing. Correct me if I am wrong, but this sounds much more serious.

She is in the 95th percentile for length, but 50th percentile for weight. She has a humongous appetite, but is very thin. She is active and has been pulling herself up and standing alone along furniture since she was 6 months old. She has always been a happy, healthy baby.

I have looked up these conditions on the net (anemia, swollen glands) and found them similar to those of lymphocytic leukemia. What type of tests need to be run on her to rule this out? Also what other problems could these symptoms indicate?

After losing my mother to cancer at a very young age due to initial misdiagnosis, I do not want to take any chances with my beautiful little girl. When my mother went in with pain in her liver area, they didn’t even think of cancer. They sent her home with pain pills only to find a few months later it was cancer. By then it was too late. That is also why I am so worried. Please give me all the information you can.
Shelley Haukoos – Industrial Lab Tech – Hibbing, Minnesota

Lymph Nodes

Dr. Greene’s Answer:

Almost every day, Shelley, concerned parents ask me about lumps in their children’s necks or scalps. Most of the time, these turn out to be normal. Occasionally, though, they are an early sign of a serious infection or malignancy. No wonder, then, lymph nodes are such a cause of concern — particularly for those who have had a previous experience with cancer. All of us have hundreds of lymph nodes scattered throughout our bodies as a critical part of our immune systems. This network of nodes functions as a powerful, intelligent filtration system to keep the insides of our bodies clean and healthy.

Tiny vessels called lymph vessels carry germs, foreign particles, and unhealthy or malignant cells to the lymph nodes, where they are trapped. Active lymph nodes enlarge as they attempt to destroy the unwelcome material.

The lymph nodes also function as schools. Lymphocytes, a type of white blood cell, study the foreign material so that they can produce antibodies, killer cells, and other substances to protect the body from the threat.

Sometimes the lymph nodes are overwhelmed in the process. Our defenders can be taken over by a cancer or an infection. These enlarged nodes can become a refuge where the invaders can hide and proliferate.

In a newborn infant, the lymph nodes are often small enough and soft enough not to be felt. But by the time a baby is several months old, healthy, growing, learning lymph nodes are frequently obvious enough to be noticed by parents — to their alarm.

When evaluating enlarged lymph nodes the first consideration is whether these nodes are localized (in one or two adjacent regions of the body) or generalized (spread throughout the body, often including the spleen — the largest lymph node — which is found just under the rib cage in the left upper part of the abdomen). Generalized enlarged lymph nodes suggest that the body is responding to a whole-body problem, such as an infection (bacterial, viral, or fungal), an autoimmune disease (arthritis or lupus), a drug reaction, or a malignancy such as leukemia. The infection might be very mild, or might be as serious as HIV.

Localized enlarged lymph nodes are responding to events in the part of the body filtered by those nodes. A scratch on the finger can produce swollen nodes at the elbow and /or the armpit. Minor trauma to the foot is filtered by nodes behind the knee and in the groin.

The localized nodes most often noticed by parents are those around the head (especially near the base of the skull) and neck. They frequently grow in response either to the mouth organisms that enter the body during teething, or to the tiny particles that get into the scalp from a baby’s lying down most of the day, or to respiratory infections of all kinds (ear infections, colds, sinus infections, etc.) — or, to some combination of these.

Much less commonly, head and neck nodes can grow from cat-scratch-fever, tuberculosis, drinking unpasteurized milk (mycobacterial infections), or eating undercooked meat (toxoplasmosis). They can also grow from an isolated malignancy, such as a lymphoma.

Many people have a sunny attitude toward “swollen glands,” not believing they will really be serious. Others believe these lumps to be harbingers of doom. The truth is somewhere in between. Most of these situations turn out to be fine, but enlarged lymph nodes should be respected.

When should you be concerned?

When examining your child, your physician will pay attention to several important signs:

  • Location — enlarged lymph nodes just above the collar bone but below the neck often indicate serious disease.
  • Character — nodes that are hard, non-tender, and irregular are very suspicious. Normal nodes are mobile beneath the skin. Fixed nodes, those that are firmly attached either to the skin or to deeper tissues, are often malignant. Nodes that are tender, inflamed, or rubbery in consistency usually represent an infection.
  • Growth — enlarged nodes that continue to enlarge rapidly should be evaluated rapidly.
  • Associated symptoms — fever, night sweats, or weight loss accompanying enlarged lymph nodes should be investigated thoroughly.
  • Size — size does matter! The definition of an enlarged lymph node is size larger than one centimeter (0.4 inch) in diameter. Pea-size lymph nodes are not enlarged, even if you didn’t feel them there before. Any node that is larger than 1cm in diameter should be followed closely by a physician. It should shrink noticeably within 4-6 weeks, and should be less than one centimeter within 8-12 weeks. High-risk enlarged nodes are those larger than 3cm (more than an inch) in diameter.

If lymph nodes remain truly enlarged for more than 2 weeks, or if other worrisome signs are present, then the next steps of evaluation include a complete blood count with a manual differential (CBCd)l. This test looks at the number and type of cells in the blood. Isolated anemia is not usually a problem, but anemia with an unusual white blood cell count or platelet number is worrisome. An abnormal CBC can be diagnostic of leukemia and lymphoma, but it is important to note that most children with neck malignancies have normal CBC’s.

Other simple tests include a sedimentation rate (a general blood test that indicates whether something significant might be going on in the body as a whole), blood chemistries (LDH is often elevated in malignancies, AST and ALT are often elevated in infections that cause enlarged lymph nodes), and a tuberculosis skin test. Depending on the results, other studies might include tests for specific illnesses (mono or HIV), and an x-ray or an ultrasound to get a better picture of what is going on.

If the node remains enlarged (greater than 1cm) for 2 to 3 months, or continues to grow after 2 weeks, then a biopsy of the lymph node may be indicated, unless the physical exam and lab tests are convincingly reassuring. At least half of the time, a biopsy does not reveal a definite cause for the enlargement, but the biopsy can rule out cancer and other serious problems.

Shelley, you bring to this situation your love as a mother, your difficult experience with the misdiagnosis of your own mother, and your determination to seek the best information available about swollen glands. Your pediatrician brings a wealth of knowledge, a practiced objectivity, and the experience of examining and following many lymph nodes. Together you have what it takes to ensure the best care for your daughter, as you keep the lines of communication open.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Primrose

    Hi Dr,

    A friend of mine, her son is having swollen lymph nodes on and off behind the ears, is it normal?

  2. Joya

    Hi doctor..
    Please tell me that tb lymphnode on collobone (neck) will occure to my colleague and she is 30year old and suffering badly to weakness …Can you tell me that it is curable decease? or what are the precaution she take for her………she is under treatment…how much time it will take to cure. It will be dangerous or curable. what are the diffrent stages of that tb.

    pls share your view.

  3. brahm kataria

    Hi doctor..
    Please tell me that tb node on neck will occure twice …my brother is under treatment of tb node on neck..it will occure again…i n worried…ot will be dangerous or curable..he is at age of 39 and sugar patient also…

  4. Nalena

    My son has had enlarged lymph node since the day he was born. He is now 7 months. I am rather worried even though his doctor said he is fine. Should i get someone else to check him?

  5. Jenna

    My daughter has had swollen lymph nodes on her neck for approximately 8 months now, she is currently 15 months old. They seem to be in a cluster at the top part of her neck. She also had a small one under her armpit on the same side. All of the lumps are movable but rubbery feeling. She does not appear to be sick in any way. Great weight and height and grows fast. She plays like a normal 1 year old as well. I can’t help but stress about this as my sister had lymphoma. I have taken her to one doctor who said he was not concerned about them but I’m still worried because they haven’t gone away or gotten smaller. Do I need to be concerned about this being something serious? And should I take her for a second opinion?

    • You should never worry about offending a doctor by getting a second opinion. The fact that you’re worried is reason enough to get one. If all it does is set your mind at ease, it’s worth the time and expense.

  6. yericka

    Hi doctor!
    My baby is 5 weeks old and he has a pea size, squishy ball on the back of his head. He was fighting a cold, can that be the reason that appear?

    Also, sometimes it seems like its hard for him to breath. His pediatrician said it is normal, but I don’t think so because I’ve never seen a baby do that before. Could that also be the cause of the litte ball?

  7. danielle

    My 2 year old daughter has a lump on the side of her neck about a cm in size. It’s soft and movable under the skin. She has had a cold recently so I thought it was a lymph node? But i did notice it a few weeks before she got ill. Ive taken her to see a nurse and a doctor who have both said its her lymph nodes and that they will go down, bur it’s still there. It hasn’t gotten any bigger and she’s well. Should I be concerned? Thanks.

    • MOHAN

      My 2 children have Lymph nodes on the neck, but they are active. I am taking my son to a homeopathy hospital for the treatment for future precaution. I have not found any problem with my children, but I am following with the doctor prescribed pills for the child.

      One think I can make you alert, please be careful if your child is suffering with a cold or fever twice or thrice in a month. This may leads to enlarged lymph nodes and infection creating.

      But before worrying with all this, consult the best Paedritician and the same I have consulted. Doctor said not to worry until / unless the lymph nodes enlarge — i feel this is wrong and the doctor said to have proper nutrition food for the child-that I am taking care.

      My advice to consult anyone of the specialist for this or Homeopathy for future safety of the child.
      But I heard (and searched on the Internet) that this problem can be solved through homeopathy pills instead of surgery.

  8. Kylie

    I would really be grateful for some advice on my son’s health, please.

    Around Halloween time my son started with a nasty dry cough and I also noticed the lymph nodes in the right side of his neck were swollen. I took him to our GP whom told us it was a viral infection so I was ok with this at first. I kept a close eye on my son and about a week or too after he started with this, he started to have trouble swallowing food and then often started to choke and needed more water to while eating to help him swallow.

    When it got to Christmas and there was still no change, I went back to the GP who again said it was viral. Then it got to the 9th of January and my son was extremely ill with a high temp and still having the previous symptoms. He was admitted to hospital with an infection in his lymph nodes on the right side of his neck.

    After finishing the course of antibiotics he improved only by the fact his temperature wasn’t high any more, but his other symptoms remained — the cough and trouble swallowing. By this point my son was also coughing so much and so violently he was also vomiting with it, and going extremely red in the face.

    After this point I noticed his lymph nodes in his arm pits and groin were also now swollen. He had started having nose bleeds and diarrhea, pains in his stomach and legs. So yet again I took him to my GP who did a full blood count to rule out any cancers and other things. It all came back clear. But still over two weeks later there is still no change. My son hasn’t gotten any better its going on to the 14th week now and I am extremely worried.

    My GP isn’t wanting to look into this any more and has put it down to a bad winter making my son ill.

    I am not happy. I want to find out what is going on with my son. His lymph nodes are still swollen so I am concerned his problems maybe be connected to his lymph nodes. Are there any more tests that can be done for my own peace of mind to make sure everything is ruled out and there is nothing being missed?

    I had a very good friend who died from non-hodginks lymphoma that was diagnosed late. This is my main concern as a lot of what my son is going through is the same as what my friend went through. Any advice would be extremely helpful thank you.

    Kind Regards.

    • Jessica

      I hope you have sought a second opinion. These symptoms sound serious. Do you have an update on your son’s condition. Many prayers!

  9. carmen

    Can you please tell me if I should be worried. My daughter is 3 years old and has tested HIV and TB negative. She has this big glands in her neck and also in her head. What is the problem?

  10. Chin

    Hello Doctor,

    My son was 4 years old and we noticed a lump at his collarbone and 3 small lump on his neck. I asked our GP last August and he stated it’s ok as my son was healthy and no other symptoms. Now it’s been 5 months. He still has it and now he says it’s painful sometimes. Please, do I need to have my son checked again. I’m really worried.


  11. stephanie

    Hi.. I’ve had a lump in my abdomen lower left side for almost 6 months it doesn’t hurt but around the clock I’m cramping and a few months ago I skipped a whole menstrual cycle. .sometimes I feel another lump either side of my belly button..I was referred to do CT scan but couldn’t gather the money and to be honest was scared of finding out bad news..my grandfather died of leukemia a couple years ago..on both sides of my family cancer has been problematic..I had low energy before I felt the lump so it’s hard to say if it’s the reason I feel weak and fatigued. .emergency room doctors won’t do an ultrasound or ct scan..but same my lymph node is swollen for an unknown reason and it may be leukemia. .what are the chances it is I guess that’s my question?

  12. Kylie

    My grandson is almost 1 years old he had lumps under his armpit. They develop to his head and back of his neck. The doctor said it’s swollen lymph nodes and prescribe him antibiotics and Advavtan cream. Can you please help me? Is that the right treatment and do I need to be concerned?

    • Kylie

      Can you give me advice about this


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