Swollen Lymph Nodes in Babies

When to get help

Get help now if a swollen node comes with any of the signs the American Academy of Pediatrics (AAP) symptom checker treats as urgent:

• a node in the neck causing trouble breathing, swallowing or drinking;
• red skin over the node, or a node getting much bigger over 6 hours or less;
• a fever in a baby under 12 weeks old (the AAP says not to give fever medicine before your baby is seen);
• a child who looks or acts very sick.

In the UK, the NHS says to ask for an urgent GP appointment or contact NHS 111 if swollen glands come with real difficulty swallowing or breathing. If your baby is floppy, hard to wake or has a rash that does not fade under a glass, follow when to call a doctor or emergency services.

Swelling behind the ear that pushes the ear outwards is not a gland problem to watch. The NHS lists the signs of mastoiditis, an infection of the bone behind the ear, as pain or tenderness behind the ear, redness, swelling that can make the ear stick out, discharge from the ear, a high temperature, and tiredness and irritability. It advises an urgent GP appointment or NHS 111, because untreated mastoiditis can lead to permanent hearing loss or meningitis. It is more likely after a severe ear infection or repeated ones.

Contact a doctor within 24 hours, in the AAP's guidance, if a node measures 2.5cm or more, is very tender, limits movement of the neck, or your baby is under 3 months old, or if a fever has lasted more than 3 days.

Book a GP appointment if a node feels hard or does not move when you press it, sits just above or below the collarbone, keeps getting bigger, or comes with night sweats or no sign of any illness to explain it; that is the NHS list. The AAP adds unexplained weight loss, easy bruising or bleeding, and swollen nodes in several parts of the body.

Why babies get lumps at the back of the head

Lymph nodes you can feel at the back of the head and behind the ears are a common finding in babies. A 1983 study of lymph node patterns in children, published in Clinical Pediatrics, described occipital (back of the head) and postauricular (behind the ear) nodes as "a common nonspecific finding in infancy". Over the age of 2, the same study found them rare enough to be a useful clue to something specific.

The same paper found nodes in the neck and under the jaw were rare in infants under 12 months but common in older children. Nodes just above the collarbone were "probably pathologic at any age".

The AAP explains that nodes at the back of the neck drain the scalp, and that it is expected for children under 5 to have enlarged nodes from time to time because they meet so many new germs. Younger children also have larger nodes.

What size is normal?

A normal lymph node in a young child is about the size of a pea. The AAP gives typical sizes of around 1cm for nodes in the neck and armpit, 1.5cm in the groin and 0.5cm near the elbow. Its symptom checker sets out how size changes the advice:

The AAP's advice is not to go looking for nodes, since you can always find some in the neck and groin, and not to squeeze swollen ones, because that may stop them shrinking back to normal size.

What makes these nodes swell

The NHS explains that glands swell near an infection to help the body fight it.

Scalp rashes and infections

Because the nodes at the back of the neck drain the scalp, and glands swell near an infection, an infection anywhere on the scalp can set them off: an infected scratch, for example, or cradle cap or eczema that has become sore or broken. The AAP notes that widespread rashes such as eczema can enlarge nodes all over the body. In children, a 2012 review in Pediatrics in Review says scalp ringworm (tinea capitis) can usually be diagnosed from how it looks, especially when nodes at the back of the head or behind the ear are swollen. It needs treatment from a doctor.

Colds, ears and throats

The NHS names colds, tonsillitis and ear or throat infections as the common causes of swollen glands, and the AAP adds sinus infections and dental problems such as decay or gum inflammation. See ear infections in babies.

Roseola

The NHS describes roseola as a very common infection of babies and toddlers that starts with a sudden high temperature, cold-like symptoms and swollen eyelids and glands in the neck. These last 3 to 7 days before a pinkish-red rash appears on the chest, tummy and back.

Rubella

The NHS describes rubella as a rare illness with a spotty rash that starts on the face or behind the ears, and lumps (swollen glands) in the neck or behind the ears. It is very unlikely if your child has had both doses of the MMRV or MMR vaccine. Call your GP rather than turning up, and keep your child away from anyone who is pregnant: rubella can harm an unborn baby.

How long do swollen nodes take to go down?

The NHS says glands swollen by an infection usually go down within 1 to 2 weeks, and advises seeing a GP if they are getting bigger or have not gone down within 1 week. The AAP is more relaxed about timing: reactive nodes usually shrink slowly over several weeks, the symptom checker gives 2 to 4 weeks after the infection has gone, and normal nodes never disappear completely. The AAP suggests calling about a large node that lasts more than a month, and says an ultrasound and blood tests may be done if nodes stay enlarged beyond 4 weeks.

Lumps in other places

Neck lumps, including those that are not lymph nodes, are on a lump on a baby's neck; groin lumps, where a hernia matters more than a gland, are on a lump in a baby's groin.

Frequently asked questions

Is it normal for a baby to have lymph nodes at the back of the head?

Yes. A 1983 study in Clinical Pediatrics called nodes at the back of the head and behind the ears a common, non-specific finding in infancy. The AAP says normal nodes are usually under 12mm, the size of a pea. Get advice if one is red, hard, fixed, 2.5cm or more, or your baby is under 3 months old.

Can teething cause swollen lymph nodes in babies?

Teething is not among the causes the AAP lists. It does list dental problems such as decay or gum inflammation, which its symptom checker links to a tender node under the jawbone. If a teething baby has a swollen node, look for the common causes instead: a cold, an ear infection or a sore throat.

What does a swollen lymph node behind a baby's ear feel like?

A reactive node is usually small and moves under your finger, and the AAP says it may be mildly tender during an infection. The warning signs are different: swelling that pushes the ear outwards, redness, tenderness behind the ear, ear discharge or a high temperature are the NHS signs of mastoiditis and need an urgent GP appointment or NHS 111.

When should I worry about a swollen lymph node in my baby?

Get help now for red skin over the node, rapid growth, trouble breathing or swallowing, or a fever in a baby under 12 weeks. See a doctor within 24 hours for a node of 2.5cm or more, and book a GP appointment for one that is hard, fixed, above the collarbone or not settling.