A lump on both sides below a child’s ear, one larger and sometimes sore: could it be a lymph node, and when is ultrasound needed?

Written by Asst. Prof. Dr. Norawit Raatpiboon. The Cornwall pathway applies to children up to their 16th birthday and only when cervical lymphadenopathy is suspected. A lump thought to be congenital follows a different guideline, which was not opened for this page.

When to call 1669, and when to be seen the same day

The NHS Greater Glasgow and Clyde emergency guideline, reviewed on 24 February 2026, lists a septic or unwell-looking child, difficulty swallowing, stridor or airway compromise, a change in voice, a significant increase in less than 4 days, and a tethered node as reasons for immediate assessment.

In Thailand, if the child looks very unwell, has stridor, or is struggling to breathe, and is not already in hospital, call 1669. If the child is already in hospital, tell the team there.

Trouble swallowing, a voice change, clear growth in less than 4 days, a suspected abscess, or a systemically unwell child with massive lymphadenopathy needs a same-day assessment. Drooling and limited neck movement are also findings that guideline asks the examiner to record. They are not a pattern to watch at home.

Short answer

A photo cannot name a child’s lump near the ear. Neck nodes are common after a cold and may stay palpable for weeks or months. A small mobile lump in a well child is reviewed. Fast growth or a node above the collarbone needs sooner review. Ultrasound cannot clear cancer.

A photo still does not name the lump

The Cornwall pathway, reviewed on 10 October 2025, says neck lumps are common in children and have a broad differential, usually grouped as congenital, reactive from infection or inflammation, and neoplastic. Although the majority are due to benign self-limiting disease, that sentence describes the pathway. It is not a reading of one child’s photograph.

The emergency guideline says neck lumps have a wide range of causes, broadly congenital, inflammatory, and neoplastic, and that inflammatory masses are by far the most common among children seen in that setting. The figures on that page are about 75 in 100 for inflammatory masses and about 80 to 90 in 100 benign in origin. Those figures belong to children in that emergency guideline. They are not the result of one photograph.

A lump below or behind the ear is therefore not yet the name lymph node until the site has been examined.

The site comes from examination, not from the picture

The guidelines ask for the location because different sites are not the same structure. A smooth, rounded midline lump is the picture the emergency guideline links with a thyroglossal cyst. A lump above the collarbone is treated as higher risk in both guidelines. The emergency page says a supraclavicular node is highly predictive of a malignant mass and should prompt investigation. Bacterial lymphadenitis is usually in the front of the neck.

In front of the ear, behind the ear, under the jaw, along the neck, and in the parotid area are names a clinician gives after feeling the lump. None of the pages opened here assigns a complete disease list to each of those spots, so this page does not name a disease from the words below the ear.

A lump thought to have been present from early life, or a midline lump suspected to be congenital, follows a different path from enlarged lymph nodes. Cornwall points to a separate congenital-lump guideline. That page was not opened here, so this article does not set a watch plan or an operation for that group.

After a cold, reactive nodes are common and may last

The Royal Children’s Hospital guideline, updated April 2021, says a viral upper respiratory infection is the most common cause of cervical lymphadenopathy in children. These reactive nodes may stay palpable for weeks to months. Viral nodes may be tender and may be on one side or both. They usually settle as the viral symptoms do, with a small chance of becoming bacterial lymphadenitis.

Cornwall says that in a well child with no red flags, a lump smaller than 2 cm that is mobile and localised is likely to be simple reactive lymphadenopathy. The family is reassured and given information. Nodes between 1.5 and 2 cm can be reviewed again if they enlarge or any worrying feature appears. A lump larger than 2 cm is reviewed at 6 weeks. If it has resolved, small nodes of normal character may stay palpable for many months because of little subcutaneous fat, a superficial site, and the relative size of the neck.

Lumps on both sides are a pattern viruses can produce. They are not a certificate that nothing else needs a look. One side being larger is a finding to record. It is not, by itself, a cancer rule in the pages that were opened.

Sore, red, warm, and growing quickly is a different picture from a node after a cold

The Royal Children’s Hospital guideline says acute bacterial lymphadenitis causes enlarged nodes that are tender, usually on one side, and may be fluctuant. The emergency guideline adds that the lump is usually in the front of the neck, firm and tender, and may come with fever. The skin may be red and warm, and neck movement may be limited. A site of entry may be the mouth or scalp, and dental disease is linked with anaerobic infection in the Royal Children’s Hospital description.

If a clinician has examined the child and judges the lump to be bacterial lymphadenitis, those pathways discuss antibiotics after that examination. This page names no drug and no dose, and it does not tell a family to start a medicine. Cornwall, written for the examiner, says that if treatment is not improving at 48 to 72 hours, or an abscess is a concern, paediatric services should be contacted the same day.

Soreness alone does not rule out cancer, and a lump that is not sore is not cancer. The emergency guideline and the Royal Children’s Hospital page say tuberculosis nodes are often not tender, alongside exposure, fever, malaise, or weight loss. The Royal Children’s Hospital page considers malignancy when a node is prolonged, painless, and firm, sometimes with symptoms in the rest of the body. Cornwall lists firm or rubbery consistency as a red flag without requiring the node to be painless first.

Red flags from the opened pathways, not a new cutoff

The Cornwall red-flag list is age under 6 months, rapid progressive growth, fever, night sweats, or weight loss, an enlarged liver or spleen, a firm or rubbery node, skin tethering or ulceration, a supraclavicular site, a size of 3 cm or more, petechiae, unexplained bruising, or pallor, and known tuberculosis contact in the family. When these are present, the pathway considers blood tests and an early discussion with the paediatric consultant.

The 3 cm mark is a different job from a lump still larger than 2 cm after 6 weeks. The second figure is an ultrasound indication when red flags are absent. It is not the name cancer, and it is not an order to image every lump over 2 cm on the first day.

The emergency guideline also examines nodes in the armpit or groin, the liver, the spleen, any rash, and whether the child looks well or unwell. The Royal Children’s Hospital page says some viruses cause nodes in several regions together with an enlarged liver or spleen, so nodes felt elsewhere should be told to the clinician.

An infant under 6 months with a palpable neck lump is both a Cornwall red flag and an ultrasound indication.

Ultrasound has a job, and it does not clear cancer

Ultrasound indications in the Cornwall pathway are a focal neck mass still larger than 2 cm for more than 6 weeks, a midline neck mass, a palpable neck mass in an infant under 6 months, a suspected congenital or developmental lesion to characterise it and direct further care after paediatric or ear, nose, and throat referral, and acute lymphadenitis that is not responding, to look for an abscess and the need for further action.

That pathway states that ultrasound cannot reliably separate reactive from malignant lymph nodes and should not be used as a screening tool to exclude malignancy. A scan read as showing no abnormality is not a document that closes the name cancer.

The emergency guideline says ultrasound is the imaging of choice for neck lumps, and the decision is made with the ear, nose, and throat team and radiology, to look for an abscess or features that raise suspicion of a malignant change in a child who needs inpatient assessment. The Royal Children’s Hospital page considers ultrasound when an abscess is suspected, and includes it among tests to consider when a lump persists and the child is unwell or a specific cause is being sought. It is not an order for every child.

Blood tests and specific infections are chosen from the context

For a well child, the Royal Children’s Hospital guideline says a lump of less than 2 weeks, and a lump present for 2 to 6 weeks, does not usually need routine tests. Cornwall considers blood tests when red flags are present. The list on that page is a full blood count with film, LDH, CRP, and EBV, CMV, and toxoplasma serology.

EBV, CMV, Bartonella, and tuberculosis are not a panel for every child. The Royal Children’s Hospital page uses serology when that infection is suspected, and a tuberculosis test when tuberculosis is suspected. A cat, symptoms in the rest of the body, and a node that is not tender are questions, not a diagnosis from a photo. That page’s table places typical cat-scratch nodes in the armpit, so a neck lump plus a cat is not that disease by itself.

For a lump lasting more than 6 weeks, the Royal Children’s Hospital guideline says there are several possible causes, many viruses last up to 6 weeks, and some cases stay unexplained. In its neoplastic paragraph, the emergency guideline says nodes present for more than 6 weeks are more likely to be neoplastic and should prompt referral. Those sentences come from different pages. Time past 6 weeks is a reason for a clinician to look again. It is not the name cancer, and it does not erase the sentence that small nodes may stay palpable for many months.

What this page does not ask a family to do

Do not start an antibiotic from this page. Do not squeeze, knead, press repeatedly, or puncture the lump. If a clinician needs to see change, photographs over time with a size reference can help. Not every lump needs a photograph, and repeated feeling is not the record. Fever for 5 or more days with a rash, red eyes without pus, cracked lips or a strawberry tongue, or peeling hands is a picture the guidelines ask a clinician to consider as a different illness. It is not a name a parent assigns from the lump.

The page on a thyroid nodule that was not given medicine and the page on early thyroid symptoms answer different questions in a different place. They do not explain a lump below a child’s ear. The page on thalassemia and a neck node is for someone who already has thalassemia and the question is when a biopsy is considered.

What a pattern can suggest, and what it cannot settle

Pattern	What it can suggest	What it cannot settle
Small, mobile, after a cold	A reactive node is common in a well child	A photo still cannot confirm the kind of lump
Sore, red, warm, growing fast	Lymphadenitis or an abscess needs an examination	It is not yet a disease name, and this page starts no medicine
Both sides	Viruses can enlarge nodes on both sides	It does not close off causes that still need a look
One side larger	Uneven size is a finding to record	It is not a cancer rule by itself
Firm, fixed, or above the collarbone	These sit on the red-flag lists and need a sooner look	They are not a diagnosis
Larger than 2 cm for more than 6 weeks	Cornwall uses this for ultrasound when red flags are absent	Ultrasound does not fully separate cancer from a reactive node
3 cm or more, or age under 6 months	These are Cornwall red flags, and this infant group also has an ultrasound indication	This is not the same job as a 2 cm lump reviewed at 6 weeks
Weight loss, fever, or night sweats	These whole-body features are on the red-flag list	They do not equal cancer by themselves

Before the visit

Write down the first day the lump was felt, an approximate size, and whether it is growing or shrinking. Then use the list below with the clinician.

Prepare notes before a visit about a child’s neck lump

Questions before a visit about a lump near the ear or in the neck

Is the lump in front of the ear, behind the ear, under the jaw, along the neck, in the midline, or above the collarbone?
On examination, does it feel like a lymph node, or is it still another kind of lump?
About how many centimetres is it, and how are the 2 cm and 3 cm figures different jobs?
Does it move, or is it fixed?
Does it feel soft, firm, rubbery, or fluid-filled?
Is it tender, red, or warm?
Is there one lump, lumps on both sides, or nodes in the armpit or groin as well?
Over the recent days, has it grown, stayed the same, or become smaller?
If there are no red flags, when is the next review, and has a lump larger than 2 cm reached 6 weeks?
Is there a source of infection in the ear, throat, teeth, scalp, or skin?
Is a full blood count, a blood film, or CRP needed?
Does this history give a reason to test for EBV, CMV, Bartonella, or tuberculosis?
Has an ultrasound indication been reached?
If an ultrasound is done, which result needs the next step, given that a reassuring scan still does not clear cancer?
Is a paediatrician or an ear, nose, and throat clinician needed?
Which size or change means coming back before the planned visit?
Which whole-body features are on the red-flag list of the opened pathways?

What parents can write down for the visit

The first day the lump was felt, and a first photo and a current photo if they exist, without photographing every lump
An approximate size, and whether it is growing quickly
Whether it is sore, red, or warm
Fever, a change in weight, night sweats, tiredness, pallor, or easy bruising
Cough, a runny nose, sore throat, ear pain, or ear infection
Dental problems, or a wound or rash on the scalp or face
Cat scratches, tuberculosis contact, travel, and medicines in use
Any earlier results, and the child’s age, especially if under 6 months

Mechanism in brief

This section follows Asst. Prof. Dr. Norawit Raatpiboon. Nodes near the airway, ear, teeth, and scalp respond to a nearby infection, so they enlarge and may stay palpable after the cold has settled. A photograph does not show whether the lump moves, feels firm, or sits above the collarbone. Ultrasound can show fluid and the architecture of a lump within the indications the pathway writes down, and that same pathway says it does not fully separate a reactive node from a malignant one.

A thyroid nodule that was not given medicine is a lump in the thyroid, not a lump below a child’s ear.
Early signs of high hormone, low hormone, and a thyroid-related neck lump sorts hormone illness. It does not explain a node after a cold.
Thalassemia and a neck node is for someone who already has thalassemia, when the question is whether a biopsy is considered.

Common questions

Can a lump below a child’s ear be a lymph node?

It can be, and that is a common possibility, but a photo cannot name the lump. The Cornwall pathway reviewed on 10 October 2025 groups neck lumps in children as congenital, reactive from infection or inflammation, and neoplastic. A clinician has to feel the site first.

How long can a node stay enlarged after a cold?

The Royal Children’s Hospital guideline, updated April 2021, says reactive nodes after a viral upper respiratory infection may stay palpable for weeks to months. Cornwall says small nodes with a normal character may stay palpable for many months because there is little fat under the skin and the neck is small relative to the node.

Are lumps on both sides more worrying than a lump on one side?

Both sides are not a safety certificate, and they are not a cancer rule. The Royal Children’s Hospital guideline says viral nodes may be tender and may be on one side or both. Bacterial lymphadenitis is usually on one side.

Does one side being larger mean cancer?

No. The guidelines ask the examiner to record one side or both. They do not use uneven size alone as a cancer rule. Size, growth, firmness, fixation, site, and symptoms in the rest of the body are read together.

Does soreness mean infection and rule out cancer?

Soreness can point toward lymphadenitis, especially with redness, warmth, fast growth, and a lump on one side. Soreness alone does not rule out cancer, and a lump that is not sore is not cancer by that fact. The emergency guideline says tuberculosis nodes may not be tender.

Which firm lumps should be seen sooner?

Cornwall lists a firm or rubbery node, skin tethering or ulceration, and a supraclavicular site as red flags. The emergency guideline lists a tethered node among reasons for immediate assessment. Firmness alone is not a diagnosis.

Which size rules are different jobs?

Cornwall uses two different numbers. A lump still larger than 2 cm after 6 weeks, in a child without red flags, is a reason for ultrasound. A size of 3 cm or more is on that pathway’s red-flag list. The April 2021 Royal Children’s Hospital page defines an enlarged node as usually larger than 1 cm. That is a definition, not the Cornwall referral cutoff.

Does every child need an ultrasound?

No. Cornwall reserves ultrasound for a lump still larger than 2 cm after 6 weeks, a midline lump, a lump in an infant under 6 months, a suspected congenital lump after referral, and acute lymphadenitis that is not improving when an abscess must be looked for. A well child with no red flags does not start with imaging for every lump.

Does a normal ultrasound mean there is no cancer?

No. Cornwall says ultrasound cannot reliably separate reactive from malignant nodes and should not be used as a screen to exclude malignancy. A worrying scan still needs a conversation with a paediatric clinician.

Does every child need blood tests?

No. The Royal Children’s Hospital guideline says a well child with an acute lump, or a lump present for 2 to 6 weeks, does not usually need routine tests. Cornwall considers blood tests when red flags are present. The list on that page is a full blood count with film, LDH, CRP, and EBV, CMV, and toxoplasma serology.

When is a paediatrician or an ear, nose, and throat clinician needed?

A well child with a small mobile lump and no red flags can often be reviewed. Cornwall asks for a paediatric discussion when red flags or an abscess are suspected. The emergency guideline asks for immediate ear, nose, and throat assessment when the child looks septic or very unwell, has trouble swallowing, has stridor or airway compromise, a voice change, clear growth in less than 4 days, or a tethered node, and also for a supraclavicular node.

How do the ear, teeth, throat, and scalp relate to this lump?

The Royal Children’s Hospital guideline examines the scalp, face, ear, nose, throat, and teeth because a nearby infection is part of the history. The emergency guideline looks for dental decay and skin disease near the lump, including ongoing eczema of the head and neck. Those findings help the clinician. They do not name the lump from a photo.

Can a lump still be reactive after several months?

A small node of normal character can be, because Cornwall says such nodes may stay palpable for many months. A lump still larger than 2 cm after 6 weeks is a reason to review and consider ultrasound. The Royal Children’s Hospital guideline says a lump lasting more than 6 weeks has several possible causes, and some stay unexplained, so time alone does not name cancer.

When should the child be brought back before the planned visit?

Come back sooner if the lump grows quickly, becomes firmer or fixed, turns red or warm, or feels fluid-filled, or if fever continues, weight falls, night sweats appear, or the child looks pale or bruises easily. If a clinician has already given medicine and the lump is no better in 2 to 3 days, contact them the same day. Do not squeeze, knead, or puncture the lump.

Which symptoms need emergency care?

If the child looks very unwell, has stridor, or is struggling to breathe, and is not already in hospital, call 1669. Trouble swallowing, a voice change, clear growth in less than 4 days, or a suspected abscess needs a same-day visit. Drooling and a stiff neck are also findings the emergency guideline asks the examiner to record.

Sources opened for this page

Cornwall NHS: Cervical lymphadenopathy in children. Reviewed 10 October 2025. Next review 10 October 2027.
NHSGGC: Neck lumps, RHCG Emergency Department. Reviewed 24 February 2026. Next review 28 February 2029.
Royal Children’s Hospital: Cervical lymphadenopathy. Updated April 2021.

The 2026 British Journal of General Practice article could not be opened from the journal page or the article archive in this session, so none of its sentences are used here.

Medical disclaimer

This page is general information from the pathways opened here. It does not examine a child from a photograph, and it does not authorise an antibiotic, squeezing, or puncturing a lump. If the child looks very unwell, has stridor, or is struggling to breathe, and is not already in hospital, call 1669.