Finding a lump on your child’s neck naturally causes worry, but most neck masses in children are not serious. The vast majority of these lumps are benign, meaning they are non-cancerous, and are typically a normal sign of the body’s immune system working against common childhood infections. Given the location near sensitive structures, any newly discovered neck mass should always be evaluated by a medical professional. A healthcare provider can determine the nature of the lump through examination and appropriate testing.
What Neck Lumps Usually Are
The most frequent cause of a palpable mass in a child’s neck is reactive lymphadenopathy, commonly known as swollen glands. Lymph nodes are small, bean-shaped structures that are part of the immune system. They swell when actively filtering out infectious agents, often triggered by minor infections like an upper respiratory tract infection, a sore throat, or a dental issue. Up to 55% of young children may have palpable cervical lymph nodes, which is considered a normal finding.
These benign, reactive lymph nodes typically present as soft, mobile masses that can be easily moved under the skin. They are often slightly tender or painful to the touch, indicating inflammation as the body fights off the underlying illness. Such inflammatory lumps usually develop quickly and resolve on their own, shrinking back to normal size within a few weeks after the infection clears.
Other common, benign neck structures include congenital cysts present since birth. A thyroglossal duct cyst, for example, is often found in the midline of the neck and may move upward when the child swallows or sticks out their tongue. Dermoid cysts are another common type of midline mass, often tethered to the overlying skin. These congenital lumps are typically non-concerning unless they become infected or grow rapidly.
Characteristics of a Lump That Need Immediate Evaluation
While most neck lumps are harmless, certain characteristics, often called “red flags,” suggest a need for immediate medical evaluation. One concerning feature is the texture and mobility of the mass. A lump that feels hard or rubbery, rather than soft, raises suspicion.
A mass that is fixed or immobile is also concerning, as it is tethered to the underlying structures. Another factor is the duration and size of the lump. Any mass that persists for longer than four to six weeks, or continues to grow rapidly without an obvious cause, should be examined promptly.
A lump larger than 2 centimeters in diameter also warrants consultation. The location of the mass is highly significant; a lump found in the supraclavicular area (the space just above the collarbone) is particularly predictive of a serious condition. Furthermore, the presence of systemic symptoms alongside the lump is an indicator of concern. These include persistent fevers, drenching night sweats, or unintentional weight loss.
Diagnostic Steps After Finding a Neck Lump
When a child is brought in for a neck lump, the medical assessment begins with a detailed history and physical examination. The doctor will ask about the lump’s duration, associated symptoms like fever or pain, and recent illnesses. During the physical exam, the doctor will assess the lump’s size, location, consistency, and whether it is mobile or fixed.
If the lump is small, tender, and mobile—suggesting a benign reactive node—the doctor may recommend “watchful waiting.” This involves re-evaluating the mass in a few weeks to see if it shrinks on its own, especially if the child recently had a minor infection. If the lump does not resolve, or if any red flag characteristics are present, further investigation is necessary.
The first step in diagnostic testing is often an ultrasound, a non-invasive procedure that uses sound waves to image the mass. The ultrasound can determine if the lump is solid tissue, a fluid-filled cyst, or a cluster of lymph nodes. Blood tests may also be ordered to check for markers of infection or to look for specific infectious agents, such as those causing mononucleosis or cat-scratch disease.