Causes

• Swollen nodes with a viral infection are usually ½ to 1 inch (12 -25 mm) across.
• Swollen nodes with a bacterial infection are usually over 1 inch (25 mm) across. This is about the size of a quarter.
• The cervical (neck) nodes are most commonly involved. This is because of the many respiratory infections that occur during childhood.
• Swollen, tender nodes under the jawbone can be caused by tooth decay or abscess.
• Elsewhere, localized nodes are usually reacting to local skin irritation or infection.

Common Objects Used to Guess the Size

• Pea or pencil eraser- 1/4 inch or 6 mm
• Dime- 3/4 inch or 18 mm
• Quarter- 1 inch or 2.4 cm
• Golf ball- 1 1/2 inches or 3.6 cm
• Tennis Ball- 2 1/2 inches or 6 cm

Return to School

• Swollen lymph nodes alone cannot be spread to others. If the swollen nodes are with a viral illness, your child can return to school. Wait until after the fever is gone. Your child should feel well enough to join in normal activities.

1. What You Should Know About Normal Nodes:
   • If you have found a pea-sized or bean-sized node, this is normal. Normal lymph nodes are smaller than ½ inch or 12 mm.
   • Don't look for lymph nodes, because you can always find some. They are easy to find in the neck and groin.
2. What You Should Know About Swollen Nodes from a Viral Infection:  
   • Viral throat infections and colds can cause lymph nodes in the neck to get bigger. They may double in size. They may also become tender.
   • This reaction is normal. It means the lymph node is fighting the infection and doing a good job.
   • Here is some care advice that should help.
3. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.
4. Fever:
   • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
   • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
   • For babies, dress lightly. Don't wrap in too many blankets. Reason: Can make the fever higher.
5. No Squeezing:
   • Don't squeeze lymph nodes.
   • Reason: This may keep them from shrinking back to normal size.
6. Return to School:
   • Swollen lymph nodes alone cannot be spread to others.
   • If the swollen nodes are with a viral illness, your child can return to school. Wait until after the fever is gone. Your child should feel well enough to participate in normal activities.
7. What to Expect:
   • After the infection is gone, the nodes slowly return to normal size.
   • This may take 2 to 4 weeks.
   • However, they won't ever completely go away.
8. Call Your Doctor If:
   • Node gets 1 inch (2.5 cm) or larger in size
   • Big node lasts more than 1 month
   • Your child becomes worse