Swollen glands or lymph nodes are a frequent concern for parents, since they're so common in children. Young children often have swollen glands because their bodies' defenses are constantly at work trying to protect them from new germs they encounter every day. In most cases, the swelling goes down once the body fights off the offending germ.

Here's what parents need to know about swollen glands in children, including what's normal and when to talk with your child's pediatrician.

Lymph nodes are part of the lymphatic system, which works with the immune system to protect the body from illness. The job of lymph nodes is to filter lymph fluid, trapping germs like viruses and bacteria while helping immune cells respond.

It is common and expected for children, especially younger than 5 years of age, to have enlarged lymph nodes from time to time. Younger children encounter many new germs as they grow, so their immune systems are often very active. When lymph nodes are busy doing their job, they can temporarily become larger. Many swollen lymph nodes shrink within a few weeks, though some may take longer to return to normal size.

Lymph nodes are all over the body except for the brain and heart. There are around 600 lymph nodes everywhere in the body, including the neck, under the jaw, underarms, groin, chest and abdomen. The lymphatic system is connected by lymph vessels, thin tubes similar to blood vessels that carry lymph fluid instead of blood. The lymphatic system also includes the tonsils, spleen and appendix.

Lymph node size varies depending on their location and the child's age. Younger children typically have larger lymph nodes. Lymph nodes under the arm and in the neck are around 1 centimeter. The groin lymph nodes are slightly larger at 1.5 centimeters and lymph nodes in the arms next to the elbow are about .5 centimeter.

Lymph nodes often become more noticeable when your child has a sore throat, dental issues, and viral infections like common colds or bacterial infections such as ear or sinus infections. Swollen lymph nodes are typically not a sign of cancer in children. Most swollen lymph nodes are caused by infections and are not serious.

Most swollen lymph nodes in children are called "reactive" lymph nodes. This means they are responding to an infection or inflammation nearby. This is most often noticed in the neck lymph nodes as they get bigger and their consistency can change while fighting the infection. Sometimes these lymph nodes can become tender as they take several weeks to return to their normal state.

Infected lymph nodes are less common than their reactive counterparts and are usually caused by a bacterial infection of the lymph node itself. When nodes themselves get infected, the child often has a fever and the node may become red, warm, painful and larger. To treat this, they may need antibiotics, and rarely, drainage if treatment doesn't work.

Your doctor may want to examine the lymph nodes and other areas of the body to check for other enlarged lymph nodes or figure out where the source of infection is. If the lymph node itself is infected, the doctor will likely prescribe an antibiotic. The infected lymph node may eventually need drainage if antibiotics do not work. Be sure to let the child's provider know about other symptoms like cough, fevers, exposure to animals and travel.

If lymph nodes stay enlarged for longer than 4 weeks, an ultrasound and bloodwork may be needed to help evaluate the lymph node further and investigate other causes.

Serious causes of swollen lymph nodes in children are rare but call your child's doctor right away if a lymph node is hard, growing rapidly or located above the collarbone. Additionally, contact your child’s pediatrician if the swelling or tenderness lasts longer than five days

Other signs a pediatrician should be informed include unexplained weight loss, night sweats, easy bruising or bleeding, extreme tiredness, loss of appetite, trouble breathing, enlarged nodes in multiple areas of the body, and an ongoing fever higher than 101 degrees Fahrenheit or 38.3 degrees Celsius.

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Mahvash Madni MD, FAAP, is a general pediatrician at St. Mary's Healthcare in Amsterdam, New York, a spokesperson for the American Academy of Pediatrics and creator/host of the Child Health Podcast "Down The Yellow Brick Road... A Journey With Your Pediatrician."

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