Swollen glands in a child's neck: when it's harmless and when to see a GP

You're drying your child after a bath, run a hand down their neck and feel a small, firm lump under the jaw. Maybe two. Swollen glands are very common in young children, especially under the age of 5. A few clear signs tell you whether you can keep an eye on them at home or whether someone should take a look.

Are swollen glands in a child's neck dangerous?

Swollen glands in a child's neck are usually harmless. They are normally the body's response to an infection such as a cold or tonsillitis, and they usually get better by themselves within one to two weeks. Get them checked if a gland becomes red and painful, feels hard, keeps getting bigger or has not gone down after a week.

Glands, also called lymph glands or lymph nodes, are part of the immune system. They swell near an infection to help the body fight it, so a sore throat often shows up as swollen glands in the neck. They feel like tender lumps on each side of the neck or under the chin, and sometimes a gland on just one side swells. Your child may also have a sore throat, a cough or a high temperature.

According to NHS Healthier Together, lymph nodes less than 2 centimetres across are unlikely to mean anything serious, and small nodes under 1cm that move under the skin are simply normal. Children with eczema sometimes have swollen lymph nodes too; they improve when the eczema is treated.

When do you need help straight away?

A swollen gland rarely becomes an emergency on its own. It does when your child cannot swallow their own spit or is struggling to breathe, or seems seriously unwell. A baby under 3 months with a temperature of 38C or more, or any child with a temperature below 36C, also needs urgent help: go to A&E or call 999.

Most of these signs come from the NHS Healthier Together page on swollen glands for parents. Not being able to swallow spit, severe breathing difficulty and severe stomach pain are 999 signs on the NHS glandular fever page.

One step down are signs that need a doctor or nurse the same day. Ring your GP surgery today or call NHS 111 if your child:

• has had a fever of 38C or above for more than 5 days
• has a gland that becomes painful and red, or a gland that is getting bigger quickly
• has lymph nodes bigger than 2 centimetres for more than 6 weeks
• has unexplained bruising, weight loss, or night sweats that soak the bedding so you need to change the sheets
• has swollen glands in lots of different areas of the body
• has leg pains or a limp
• was prescribed antibiotics and the fever has continued for more than 2 days, or the gland has not got smaller after 5 days
• lives in the same household as someone with TB
• has swollen glands and finds it very difficult to swallow, or difficult and painful, or has difficulty breathing

The last point comes from the NHS swollen glands page, which asks for an urgent GP appointment or NHS 111, and from the glandular fever page, which sends difficulty breathing and painful swallowing to NHS 111. If a sign fits more than one list, act on the higher one. If your child's condition gets worse, seek medical advice again straight away.

When can you wait, and for how long?

If your child seems well and has none of the signs above, you can watch the glands at home. Look out for any change and for the warning signs in the lists.

Swollen glands should go down within one to two weeks, depending on the cause. Your child should start feeling better within a couple of days, although the glands themselves may take 2 to 4 weeks to settle. Small nodes under 2 centimetres, particularly in the neck, that stay or change in size are rarely a concern. Even so, see a GP, without urgency, if the glands:

• are getting bigger or have not gone down within a week
• feel hard or do not move when you press them
• come with night sweats or a very high temperature, where your child feels hot, cold or shivery
• are there without any other signs of illness or infection
• sit just above or below the collar bone

Lymph nodes that stay bigger than 2 centimetres for longer than 6 weeks need checking by a specialist, but most of these turn out to be normal. In the meantime at home, rest and plenty of fluids help. Paracetamol or ibuprofen can keep your child comfortable; follow the instructions on the packet, and do not give aspirin to children under 16. If you're still worried at any point, call NHS 111. Do not try to work out the cause yourself; see a GP if you're unsure.

What is causing the swelling?

Usually a common infection. Less often, the swelling needs its own treatment.

An infection nearby

Swollen glands are often caused by colds, tonsillitis and ear or throat infections. Painless, big glands on both sides of the neck together with a sore throat are likely to improve without antibiotics. A large, hot, painful gland can be a bacterial infection of the gland itself, which needs antibiotics.

Glandular fever

Glandular fever is a viral infection that mostly affects teenagers and young adults; it is most common between 15 and 24. Besides swollen glands it can bring a high temperature, a sore throat, a rash, headache and tiredness. See a GP if your child has a very high temperature, a severe sore throat, swelling on either side of the neck, extreme tiredness, or a sore throat that is not getting better. It usually gets better by itself within 2 to 4 weeks. Your child should avoid strenuous activities such as sport, and can go back to school as soon as they start to feel better. Antibiotics do not help, because a virus causes it.

Do they need antibiotics?

Usually not. Antibiotics are not normally needed for swollen glands, and they do not work on viral infections. Whether your child needs antibiotics or another treatment is a decision for your GP, who will recommend treatment depending on the cause.

Could it be cancer?

Many parents wonder this, and it's a fair question. Swollen glands are rarely caused by anything more serious, like leukaemia or lymphoma, and very rarely by an infection such as TB. That is why hard glands that don't move, weight loss, night sweats and glands that keep growing or don't go down are on the lists above. Even nodes over 2 centimetres that last longer than 6 weeks mostly turn out to be normal when a specialist checks them.

How do you keep track of the swelling?

Whether a gland is growing, staying the same or shrinking only shows when you compare it over days and weeks. Several of the NHS signs above are about exactly that: time.

The GP will ask: When did you first notice it? Has it got bigger or smaller? How many days has the fever lasted? Has the gland got smaller since the antibiotics started? Three weeks in, few parents remember which day the lump first appeared. The note that said "left side, pea-sized" has long since gone out with the recycling.

In Mona you log the swelling as a symptom with the date and a short note, plus every temperature reading with its time. Describe the size with the same comparison each time, a pea or a cherry stone, for example. At the appointment the timeline answers the GP's questions with what actually happened, instead of a guess from memory.