Introduction: Lymph node enlargement is a common clinical presentation among the pediatric population. Several pathologies with variable etiologies, ranging from inflammation to malignancy, may cause lymph node swelling. Objective: The objective of this study was to evaluate the etiopathology and cytomorphological patterns of enlarged lymph nodes in patients of pediatric age-group by fine needle aspiration cytology (FNAC). Materials and methods: This was a hospital-based observational cross-sectional study done in a tertiary care hospital of northeastern India from June 2017 to May 2018. Patients from 0 to 18 years of age who presented with superficial lymphadenopathy were included. Fine needle aspiration (FNA) was done from involved lymph nodes, and smears were stained with May–Grünwald Giemsa (MGG), Papanicolaou, and Ziehl–Neelsen (ZN) stains. Cytomorphological evaluation was done for each case. Results: A total of 186 patients were included. Eleven cases were excluded afterward due to various reasons. Among the rest of the patients, 87 (49.71%) cases were of nonspecific reactive lymphadenitis (NSRL), 58 (33.14%) cases were detected with tubercular lymphadenitis, 16 (9.14%) cases were diagnosed with acute suppurative lymphadenitis, 6 (3.43%) cases were of metastatic lymph node diseases, 5 (2.86%) cases were of non-Hodgkin lymphoma (NHL), and 3 (1.71%) cases were reported as Hodgkin lymphoma (HL). The most commonly affected lymph node region was the cervical region (83.43%), followed by the axillary region (9.14%) and the inguinal region (3.43%). Seven (4%) cases presented with generalized lymphadenopathy. Conclusion: In this study, common causes of lymphadenopathy and the distribution of affected lymph nodes are elaborated in patients of pediatric age-group.