Lumps on the Neck

Dear Lisa,

My son has one lump on the lower back of his head more on the base right before the neck starts, about the size of the tip of my thumb, less than a nickel but more than a dime I think. Further down on the same side of neck still more on the side, he has two littler lumps, the size of the tips of my pinky. They are not external because you can’t see them just feel them and if he moves his head to the side you can see the smaller ones.

“Concerned not sure what to think”

Dear “Concerned not sure what to think”,

The lumps that you are describing sound like normal posterior cervical and occipital lymph nodes. Another words, lymph nodes in the neck area and at the base of the scalp. Everyone has lymph nodes scattered throughout their body. The purpose of a lymph node is to remove bacteria, foreign material and dead cells from the body. If you inspect the neck of a normal healthy child you may find lymph nodes which are rubbery in texture, painless, soft, mobile and round. The size of lymph nodes range from 1 to 25 mm (or 0.04 to 1 inch). (1) Therefore it sounds like the bumps you are describing are within normal range since a nickel is 20 mm or less than an inch. Many parents report seeing lymph nodes or “bumps in the neck” when their child turns his/her head sideways.

Since the lymph node size increases in response to infection or cell breakdown, it is important to check the area above the lymph nodes that you see in order to determine what is causing them to enlarge. Sometimes you may find something as small as a scratch or bug bite on the face or scalp. Other times a tick may be found on the scalp or behind the ear. A child with a throat infection, ear infection or rash on the scalp will have enlargement of the lymph nodes in the neck area. Therefore if your son has had a fever, decrease interest in eating, a sore throat, scratching of his scalp, waking at night or ear pain, it would be a good idea to have him checked by his health care provider to rule out a throat infection, ear infection or skin problem.

Sometimes the number or germs that enter the lymph nodes is so great that the body cannot remove or detoxify them fast enough. If this occurs the lymph node may become infected. Signs of a lymph node infection include warmth at the site, redness, enlargement of the lymph node, pain or tenderness with palpation (touch) or fever. If any of these signs occur your child should be evaluated by your Doctor or Nurse Practitioner.

Lumps that are hard, larger than 1 inch, painful, not mobile when touched, interfere with movement or associated with a skin rash may represent a different problem and should be evaluated by your Doctor or Nurse Practitioner.

(1)Tortora, G., Anagnostakos, N. Principles of Anatomy and Physiology. Harper & Row Publishers, New York. Fourth Edition;1984:520-521.


Lisa Kelly R.N., P.N.P., C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website