When Should Parents Be Concerned About a Lump on Their Child’s Head or Neck?

We know that as a parent, you want nothing but the best for your child. So when you find a lump on their head or neck, it can feel overwhelming and leave you unsure where to turn. But rest assured, you aren’t alone.

Keep reading to learn from Joseph Lopez, MD, MBA, Chief of Pediatric Head and Neck Surgery at AdventHealth for Children, about pediatric head and neck tumors, including signs and symptoms, common questions parents have and the importance of early detection.

Understanding Pediatric Head and Neck Tumors

Parents may wonder whether lumps on their children’s heads and necks are simply swollen lymph nodes from a cold or infection, or something more serious. “The reassuring news is that most head and neck lumps in children are not cancerous. Research on head and neck masses in kids tells us that 75 to 90% are benign,” said Dr. Lopez.

Many things can cause benign head and neck lumps in children, including swollen lymph nodes, congenital cysts, vascular anomalies and other noncancerous conditions. That’s why the goal isn’t for parents to try to diagnose cancer at home. Instead, parents should recognize patterns that deserve medical attention — especially a lump that’s persistent, enlarging, firm, fixed or associated with other unexplained symptoms.

“Most of the time, these lumps are related to infection, inflammation or another noncancerous condition. What matters is recognizing when a lump or symptom is not following the expected course,” explained Dr. Lopez. Children commonly develop enlarged lymph nodes when their immune system responds to an infection. A child may have swollen nodes in the neck during or after a cold, a sore throat, an ear infection or another illness. Many of these lumps improve as the underlying illness improves.

Signs and Symptoms of Head and Neck Tumors in Children

“It’s concerning when a lump persists, grows, feels unusually firm or doesn’t behave like a typical lymph node associated with an infection,” shared Dr. Lopez. One of the most important things for parents to know is that a suspicious lump isn’t necessarily painful. In fact, some pediatric head and neck cancers, including lymphoma, commonly involve a painless neck lump. That’s why it’s important to remain mindful of other symptoms.

Signs that a lump should be checked include:

• Appearing in the lower neck or near the collarbone
• Changes in the skin or surrounding tissue
• Feeling fixed or stuck in place
• Feeling unusually hard or firm
• Frequent recurrence after healing
• Not going away or continuing to grow
• Not improving as expected after treatment for an infection

Whole-body symptoms to watch for include:

• Night sweats
• Persistent or unexplained fever
• Unexplained weight loss
• Unusual fatigue

Nose, throat and breathing symptoms to look for include:

• Changes in the voice
• Frequent or unexplained nosebleeds
• Ongoing nasal congestion or blockage
• Trouble breathing

Symptoms to watch for in relation to the face, eyes, ears and mouth include:

• Eye bulging or other changes around the eye
• Facial swelling or a feeling of fullness
• Jaw swelling
• Loose teeth without an obvious dental explanation
• Persistent ear symptoms or hearing changes
• Persistent or unusual facial pain
• Vision changes

Thyroid or central neck changes to remain aware of include:

• A feeling of fullness in the front of the neck
• A mass that feels fixed in place
• A new lump or nodule

These symptoms can have many causes that have nothing to do with cancer. But when they’re persistent or unusual, they should be evaluated. Parents should also know that repeated healthcare visits for the same problem without improvement can be an important clue that something else is going on. Symptoms that persist despite treatment require further evaluation rather than assuming they're due to an infection.

Subtle Signs to Know

One reason pediatric head and neck cancers can be difficult to recognize is that they don’t always look like a typical tumor. Some tumors develop deep inside the nose, throat, sinuses, mouth, or around the eye. So a child may have symptoms such as congestion, voice changes, nosebleeds, or facial fullness rather than an obvious mass. Dr. Lopez said that these symptoms can be “nonspecific, nonclassical and subtle.” That’s why parents should pay attention when a symptom persists, keeps returning or doesn’t improve as expected.

Answering Your Questions to Ease Your Mind

What if a Lump Is Painful?

"Pain by itself doesn't tell you whether a lump is harmless or serious," said Dr. Lopez. Some infections can cause very tender, painful lymph nodes. At the same time, some pediatric cancers present with little or no pain. For example, Hodgkin lymphoma commonly presents as painless lymph node enlargement in the neck. So rather than only asking, “Does it hurt?”, it’s more helpful to consider: Is it getting bigger? Is it unusually firm? Does it move? Is it still there? Are there other symptoms?

What Happens if Your Pediatrician Is Concerned?

An evaluation usually begins with a thorough history and physical examination. Your child’s provider may ask when the lump first appeared, whether it has changed in size, whether your child has been sick recently and whether there are other symptoms. Depending on the lump’s location and appearance, imaging may be recommended. For many superficial neck masses, ultrasound can help determine whether a mass is solid or cystic and provide information about lymph nodes and nearby structures. Other imaging, including MRI or CT, may be appropriate for deeper or more complex areas.

"If a tumor remains a concern, a biopsy may be needed to determine exactly what the mass is," explained Dr. Lopez. Imaging and tissue diagnosis are important parts of reaching an accurate diagnosis. It's important for parents to know that they don't need to figure out which test their child needs. The goal of an evaluation is to determine the most appropriate next step based on the mass’s location and characteristics.

Early Detection Can Make All the Difference

Pediatric head and neck cancers are rare, and their symptoms can sometimes mimic common childhood illnesses. That's why recognizing concerning symptoms early can help reduce diagnostic delays.

“Early evaluation doesn’t mean that a child has cancer,” Dr. Lopez said. “It means we’re making sure that an unusual or persistent finding is appropriately understood.”

When a cancer diagnosis is ultimately made, care is typically coordinated across multiple specialties. Depending on the tumor type, a child may be cared for by pediatric oncologists, surgeons, radiologists, pathologists and other specialists working together.

Helping Your Kids Thrive in Body, Mind and Spirit

Whether your child is experiencing new symptoms or you’re following up on a recent diagnosis, our multidisciplinary team of experts is here to help your little one thrive. Learn more about our pediatric head and neck program and how we can partner with your family as you journey toward whole-person health.