Definition

• A bacterial infection of a lymph node
• Main symptom is the sudden onset of one large painful node

Health Information

Symptoms

• Sudden increased size of a lymph node in the neck. Always a single node. Sometimes, it happens to a node in the armpit or groin.
• It’s much larger than the same node on the other side of the body. Sometimes, the skin that covers the node becomes red.
• Swollen nodes with a bacterial infection are usually over 1 inch (25 mm) across. This is about the size of a quarter.
• Normal nodes are usually less than ½ inch (12 mm) across. This is the size of a pea or baked bean. They also feel soft and are easy to move.

Causes

• Seen with bacterial infections of the nose, sinuses, mouth or throat. A strep throat infection is a common cause.
• One swollen, tender node under the jawbone can be caused by bad tooth decay.

Common Objects Used to Guess the Size

• Pea or pencil eraser- ¼ inch or 6 mm
• Dime- ¾ inch or 18 mm
• Quarter- 1 inch or 2.4 cm
• Golf ball- 1½ inches or 3.6 cm
• Tennis Ball- 2½ inches or 6 cm

Care Advice

1. Overview:
   • Bacterial lymph node infections always need a prescription for an antibiotic.
   • Most children get better slowly over 2 to 3 days. They do not respond to the first dose.
   • Here is some care advice that should help.
2. Antibiotic by Mouth:
   • The antibiotic will kill the bacteria that are causing the lymph node infection.
   • Give the antibiotic as directed.
   • Try not to forget any of the doses.
   • Give the antibiotic until it is gone. Reason: To stop the lymph node infection from flaring up again.
3. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
4. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
5. Avoid Squeezing:
   • Don’t squeeze lymph nodes.
   • Reason: It could force bacteria into the bloodstream. It also can slow down the return to normal size.
6. What to Expect:
   • Once on antibiotics, your child will get better in 2 or 3 days.
   • After the infection is gone, the node will slowly return to normal size.
   • This may take 4 to 6 weeks.
   • However, it won’t ever completely go away.
   • If the infected node became soft in the middle, it needs to be drained. Reason: To release the pocket of pus. Don’t try to do this on your own. Call your child’s doctor.
7. Return to School:
   • Your child can return to school after the fever is gone.
   • Your child should feel well enough to join in normal activities.
   • Lymph node infections cannot be spread to others.

Call Your Doctor If

• Fever lasts more than 2 days after starting antibiotics
• Symptoms become worse on treatment
• Lymph node comes to a head and needs to be drained
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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