Lymphadenopathy is very common in young children usually due to an intercurrent systemic viral infection or local infection.
Lymphadenopathy is more common in children under 5 years of age and generally less common in older/ teenage children.
More serious causes include: lymphoma , leukaemia, and chronic infections such as TB.
Key points in the history:
- Presence of red flag symptom – see below
- Repeat presentations to the same or multiple professionals (3 or more times)
- Age – higher degree of concern in older children > 5 years of age
- Travel history
- Possible contact with infectious diseases eg TB – ask about living with / visits from relatives from a TB endemic area .
- Ask about recent travel to areas outside the UK especially to higher risk areas.
Possible reactive causes :
- Intercurrent or recent illness
- Dental hygiene problems
- Skin conditions e.g. eczema, scalp dermatitis in infants
- Contact with pets e.g. cats / kittens
- For groin nodes – is the patient sexually active? ? – are there any local leg symptoms or signs?
Red flag symptoms / clinical features: (persistent = >4 weeks)
- Hepatosplenomegaly and/or splenomegaly and/or abdominal distension
- Persistent lethargy / malaise
- Persistent or unexplained bone pain or limp
- Unexplained bruising, petechiae or unusual bleeding
- Persistent unexplained fever
- Unexplained weight loss
- Drenching night sweats
- Shortness of breath (in the absence of acute wheeze / asthma history)
- Persistent nocturnal/supine cough in the absence of coryzal symptoms
- Symptoms of mediastinal involvement causing airway compromise (wheeze, orthopnoea, stridor) or SVC obstruction (unexplained breathing difficulties, distended neck veins, facial swelling)
- Pruritis
Please also see: Cancer in children and young people | Right Decisions
S.B, G.M. & CM 17-11-25
Who to refer to general paediatrics:
- Lymph node(s) persistent for more than 6 weeks and > 2 cms in size
- absence of any red flag symptoms
- these patients will be seen on a routine basis
- Any child with persistent lymphadenopathy > 2 cm and a significant recent travel history.
If you are uncertain about referral or need any further clinical advice, then please contact the general paediatric consultant on call 0131 536 1000 bleep 9250 9 am to 5 pm.
Who to refer to Haematology/oncology service:
- Lymph nodes which are more than 2cm and progressively increasing in size without a clinically obvious cause
- supraclavicular lymph nodes, axillary nodes or large groin nodes (>2cm)
- Presence of any red flag symptoms / clinical features, in addition to the enlarged lymph node(s) should warrant urgent discussion with the haematology / oncology team via 0131 536 1000– ask for haematology or oncology registrar: bleep 9290
- These patients will be triaged on the level of concern to either urgent haematology-oncology review or next day A&E review.
General information:
- Please do not send well children with persistent lymphadenopathy and no red flags to the Accident and Emergency Department.
Who not to refer:
- Children with persistent small pea sized (< 1 cm) lymph nodes
- Small lymph nodes may persist indefinitely following viral illness and are not a cause for clinical concern. Please reassure parents.
- Lymph nodes with a clinically obvious cause eg local eczema. Reactive lymphadenopathy is common and normal.
Investigations in primary care:
We do not currently recommend any investigations in primary care in these children as these will be undertaken in secondary care if appropriate.
