Lymphadenitis (being treated with antibiotics)

Advice for parents and caregivers

Advice intended for parent/carers taking their child home after seeing a hospital based healthcare professional

Lymphadenitis is inflammation (swelling) of the lymph nodes (glands) caused by infection. The lymph nodes are an important part of the immune system and contain cells which help to fight infection. An inflamed lymph node may be painful. The skin overlying it may be red and warm to touch. 

Symptoms

  • Fever may be present
  • Warm, tender enlarged lymph node on one side (usually in the neck, but can also be in the arm pit or groin)
  • Skin redness over the lymph nodes

Causes

Lymphadenitis in children often occurs in the neck area because these lymph nodes are close to the ears and throat, which are frequent locations of infections in children.

A single enlarged, painful lymph node is likely to be caused by bacterial infection, which will need antibiotic treatment. If your child has multiple swollen lymph nodes, this is more suggestive of a viral infection which is unlikely to require antibiotics.

When to seek further help:

If your child has any of the following:

  • Is unable to swallow their own saliva
  • Breathing very fast, too breathless to talk, eat or drink
  • Working hard to breathe, drawing in of the muscles below the ribs, or noisy breathing (grunting)
  • Breathing that stops or pauses
  • Is pale, blue, mottled or feels unusually cold to touch
  • Difficult to wake up, very sleepy or confused
  • Weak, high-pitched cry or can’t be settled
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test’)
  • Is under 3 months old with temperature more than 38°C or under 36°C (unless fever in the 48 hours following vaccinations and no other red features)

You need urgent help

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • The fever has continued for more than 2 days
  • The painful lump is increasing in size or becoming more painful despite your child being on antibiotics
  • The gland has not got smaller after 5 days
  • The head is twisted or tilted to one side (torticollis)
  • The painful lump is increasing in size or becoming more painful despite your child being on antibiotics
  • Develops twisting of their neck to one side (torticollis)
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips or tongue
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Is 3-6 months old with temperature 39°C or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Temperature less than 36°C in those over 3 months
  • Getting worse and I am still worried

You need to contact a doctor or nurse today

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

If you have been treated in hospital, please contact your hospital team.

 

If none of the above features are present

Self care

Continue providing your child’s care at home using the advice below. If you are still concerned about your child, speak to your health visitor, local pharmacist or call NHS 111– dial 111. Keep monitoring your child for red and amber features and seek help if they develop.

Lymphadenitis usually responds well to antibiotics. Treatment with intravenous antibiotics (given into a vein) is usually only needed for more severe cases or those that have not responded to antibiotics given by mouth.

Some children who need intravenous antibiotics are admitted to hospital initially whilst others can be looked after at home.

The decision on when to change from intravenous to oral antibiotics (tablets or liquid) will be made by the medical team caring for your child. This will depend on how quickly your child responds to treatment (improvement in fever, pain and sometimes their blood tests) and whether your child has other health conditions. Antibiotics are usually given for a total of 7 days. You can give regular pain relief (Paracetamol or Ibuprofen) until any discomfort has improved.

Children usually recover from lymphadenitis within 3-4 days, when given antibiotics. If your child is not responding to the antibiotic given, then further investigations may be required. This can be due to several reasons;

  • Occasionally an abscess can form and may require surgical drainage
  • Your child may have an infection caused by a less common bacteria and may need to change their antibiotic
  • Despite antibiotics, the infection may not improve or can become worse

It is not possible to prevent lymphadenitis, however, prompt review by a doctor and appropriate treatment can speed up recovery. It is important that your child completes their course of antibiotics, to prevent it from recurring.