Pre-referral guidelines for primary care providers

Lymphadenopathy (LAD) is a common phenomenon in children and is generally reactive (predominantly due to viral infections), although other diagnoses do need to be considered. Even reactive LAD can be relatively persistent in children, lasting months and sometimes years.

LAD needs to be divided into acute vs. chronic enlargement and cervical vs. generalised.

For the differential diagnoses, investigations and management of LAD, please refer to the Royal Children’s Hospital Clinical Practice Guidelines.

Referral pathways

  • Paediatrician
    • Please note that the majority of diffuse cervical LAD in children is reactive and does not require referral to a paediatrician. They can be safely watched by a General Practitioner.
    • Referral to paediatric outpatient services appropriate for the follow concerns:
      • Persistent (> 2 weeks) generalised LAD
      • Larger persistent cervical LAD
  • Emergency Department
    • any large (>10mm) fluctuant LAD
    • isolated red, tender LAD that is not responding to 48 hours of oral antibiotics
    • isolated LAD with an unwell/febrile child
    • unilateral cervical LAD with signs to suggest Kawasaki disease