{"id":4264,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatriclymphadenopathy\/"},"modified":"2026-09-23T12:42:00","modified_gmt":"2026-09-23T11:42:00","slug":"paediatriclymphadenopathy","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology-paediatric\/paediatriclymphadenopathy\/","title":{"rendered":"Lymphadenopathy"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Lymphadenopathy is very common in&nbsp;<em>young children<\/em>&nbsp;usually due to an intercurrent systemic&nbsp; viral infection or local infection.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Lymphadenopathy is more common in children under 5 years of age and generally less common in older\/ teenage children.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">More serious causes include: lymphoma , leukaemia, and chronic infections such as TB.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"text-decoration:underline\"><strong>Key points in the history:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>Presence of&nbsp;red flag&nbsp;symptom \u2013 see below<\/strong><\/mark><\/li>\n\n\n\n<li>Repeat presentations to the same or multiple professionals (3 or more times)<\/li>\n\n\n\n<li>Age \u2013&nbsp;<em>higher degree<\/em>&nbsp;of concern in older children&nbsp;<em>&gt; 5 years of age<\/em><\/li>\n\n\n\n<li>Travel history<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Possible contact with infectious diseases eg TB \u2013 ask about living with \/ visits from relatives from a TB endemic area .<\/li>\n\n\n\n<li> Ask about&nbsp; recent travel to areas outside the UK especially to higher risk areas.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Possible reactive causes :<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Intercurrent or recent illness<\/li>\n\n\n\n<li>Dental hygiene problems<\/li>\n\n\n\n<li>Skin conditions e.g. eczema, scalp dermatitis in infants<\/li>\n\n\n\n<li>Contact with pets e.g. cats \/ kittens<\/li>\n\n\n\n<li>For groin nodes &#8211; is the patient sexually active? ?&nbsp;&#8211; are there any local leg symptoms or signs?<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><span style=\"text-decoration: underline\">Red flag symptoms \/ clinical features: &nbsp;(persistent = &gt;4 weeks)<\/span><\/mark><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-1\"><strong>Hepatosplenomegaly and\/or splenomegaly and\/or abdominal distension<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-2\"><strong>Persistent lethargy \/ malaise<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-3\"><strong>Persistent or unexplained bone pain or limp<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-4\"><strong>Unexplained bruising, petechiae or unusual bleeding<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-5\"><strong>Persistent unexplained fever<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-6\"><strong>Unexplained weight loss<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-7\"><strong>Drenching night sweats<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-8\"><strong>Shortness of breath (in the absence of acute wheeze \/ asthma history)<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-9\"><strong>Persistent nocturnal\/supine cough in the absence of coryzal symptoms<\/strong><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-10\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\"><strong>Symptoms of mediastinal involvement causing airway compromise (wheeze, orthopnoea, stridor) or SVC obstruction (unexplained breathing difficulties, distended neck veins, facial swelling)<\/strong><\/mark><\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-11\"><strong>Pruritis<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Please also see: <a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf#page=19#page=57\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf#page=19#page=57\" rel=\"noreferrer noopener\">Scottish Cancer Referral Guidelines for Suspected Cancer in Children and Young People<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>S.B, G.M. &amp; CM 17-11-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer to general paediatrics<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lymph node(s) persistent for more than 6 weeks&nbsp;<strong>and<\/strong>&nbsp;&gt; 2 cms in size<\/li>\n\n\n\n<li>absence of any red flag symptoms<\/li>\n\n\n\n<li>these patients will be seen on a routine basis<\/li>\n\n\n\n<li>Any child with persistent lymphadenopathy &gt; 2 cm and a significant recent travel history.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who to refer to <\/strong><strong>Haematology\/oncology service<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lymph nodes which are&nbsp;more than 2cm and progressively&nbsp;increasing in size without&nbsp;a&nbsp;clinically obvious cause<\/li>\n\n\n\n<li>supraclavicular lymph nodes, axillary nodes or large groin nodes (&gt;2cm)<\/li>\n\n\n\n<li><strong><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">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\u2013 ask for haematology or oncology registrar: bleep 9290<\/mark><\/strong><\/strong><\/li>\n\n\n\n<li>These patients will be triaged on the&nbsp;level of concern to either&nbsp;urgent haematology-oncology review or next day&nbsp;A&amp;E review.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>General information:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please do not send well children with persistent lymphadenopathy and no red flags to the Accident and Emergency Department.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Children with persistent small pea sized (&lt; 1 cm) lymph nodes<\/li>\n\n\n\n<li>Small lymph nodes may persist indefinitely following viral illness and are not a cause for clinical concern. Please reassure parents.<\/li>\n\n\n\n<li>Lymph nodes with a clinically obvious cause eg local eczema. Reactive lymphadenopathy is common and normal.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong>Investigations in primary care:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">We do <strong>not <\/strong>currently recommend any investigations in primary care in these children as these will be undertaken in secondary care if appropriate.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf#page=19#page=57\" target=\"_blank\" data-type=\"link\" data-id=\"https:\/\/www.gov.scot\/binaries\/content\/documents\/govscot\/publications\/advice-and-guidance\/2025\/08\/scottish-referral-guidelines-suspected-cancer-2025\/documents\/scottish-referral-guidelines-suspected-cancer-2025\/scottish-referral-guidelines-suspected-cancer-2025\/govscot%3Adocument\/scottish-referral-guidelines-suspected-cancer-2025.pdf#page=19#page=57\" rel=\"noreferrer noopener\">Scottish Cancer Referral Guidelines for Suspected Cancer in Children and Young People<\/a><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Lymphadenopathy is very common in&nbsp;young children&nbsp;usually due to an intercurrent systemic&nbsp; viral infection or local infection.&nbsp; 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: Possible reactive<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":16166,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[523],"class_list":["post-4264","page","type-page","status-publish","hentry","category-paediatriclymphadenopathy"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/paediatriclymphadenopathy\/\" rel=\"tag\">Paediatric Lymphadenopathy<\/a>","rttpg_excerpt":"Lymphadenopathy is very common in&nbsp;young children&nbsp;usually due to an intercurrent systemic&nbsp; viral infection or local infection.&nbsp; 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: Possible reactive","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4264","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4264"}],"version-history":[{"count":2,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4264\/revisions"}],"predecessor-version":[{"id":30157,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4264\/revisions\/30157"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/16166"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4264"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4264"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}