What is mononucleosis?
Mononucleosis (mono) is a viral infection caused by the Epstein-Barr virus (EBV). This virus is transmitted through infected saliva. This may happen by sharing a drinking glass, utensils, or food, or through coughing, sneezing, and kissing.
Despite common belief, mono is not very contagious. People in the same house rarely come down with it at the same time. It is more common in 15- to 25-year-olds. This may be because of more intimate or closer contact with others. For most people, the EBV infection usually occurs during infancy or childhood and without the typical signs of mono developing.
Signs and symptoms of mono
In children, mono is often asymptomatic. This means it shows very few or no symptoms. Often, children have only minor symptoms of a cold or a mild to moderate fever. This fever can last up to 2 weeks. It is not dangerous.
Teens and young adults do get symptoms from mono. These can include:
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a very sore throat
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tiredness, loss of energy and body aches
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large red tonsils covered with pus that looks like cottage cheese
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swollen lymph glands in the neck, armpits, groin, and other parts of the body
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a fever for 7 to 14 days
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an enlarged spleen
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a slightly enlarged liver
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a rash
Most children have only mild symptoms for a week. Even those with severe symptoms often feel all better in 2 to 4 weeks.
Complications of mono
Most children with mono can be cared for at home. Your child will likely not need to go to the hospital. Sometimes, complications can occur with mono and may need to be looked at by a doctor. These include:
Dehydration
The most common complication of mono is dehydration from not drinking enough fluids. Try to prevent this by giving your child fluids often.
Enlarged spleen
Your child's spleen may be enlarged while she has mono, so it is important to protect her stomach or lower back area. A hit to the stomach could rupture the enlarged spleen and cause internal bleeding. This is an emergency.
All children with mono should avoid contact sports for at least 4 weeks or until cleared by their doctor. Athletes must restrict their activity until the spleen returns to normal size.
Try to prevent constipation. Your child should also avoid heavy lifting. These can put sudden pressures on the spleen.
If your child has sudden, severe pain in the abdomen (belly), take her to the emergency department right away.
Trouble breathing
Your child may have a hard time breathing. Her airway may be partially blocked by enlarged tonsils, adenoids, and other lymph tissue in the back of the throat. She may describe a feeling of "something being stuck there." Your child's doctor can examine her throat to see if there is a risk of blockage. Your child may need medicine to reduce the throat swelling.
Rash
Some children with mono develop a severe rash if they take the antibiotics ampicillin or amoxicillin. These medicines should be avoided if your child has mono. If your child's doctor suspects a bacterial infection as well as mono, other antibiotics can be safely used.
Chronic fatigue syndrome
The symptoms of chronic fatigue are extreme tiredness, weakness, and recurrent pains. The symptoms last for at least 6 months.
What your child's doctor can do for mono
Examine your child
Your child’s doctor will make a mono diagnosis by asking you about your child’s symptoms, examining your child, and perhaps taking blood tests.
Medication
There is no specific medication to treat this virus. The body’s immune system will fight the infection. Treatments are mainly given to improve your child’s comfort.
If the tonsils are so large that they are almost touching, the doctor may suggest steroid medication to decrease the swelling.
Taking care of your child with mono at home
Fever and pain medicines
The discomfort of swollen lymph nodes and fever can often be relieved with acetaminophen (Tylenol, Tempra, or other brands) or ibuprofen (Advil, Motrin, or other brands).
Fluids
Make sure your child drinks plenty of fluids. Milk shakes and cold drinks are good. Children over 1 year old can sip warm chicken broth.
Your child is getting enough fluid if:
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she pees at least 2 to 3 times per day
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she has moist eyes and tears when she cries
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her mouth is moist and has saliva in it
Sore throat treatment
If your child finds it painful to eat and drink, try the following:
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Give soft foods that are easy to swallow, such as soups, ice cream, pudding, or yoghurt.
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Avoid highly salted, spicy, acid, or citrus foods if they make the pain worse.
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Give plenty of liquids. Sipping with a straw or sippy cup may help.
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If your child is more than 1 year old, try giving 1 to 2 teaspoons (5 to 10 mL) of pasteurized honey to soothe the throat and help with the cough.
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Older children can try gargling with warm salt water.
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Ice cubes and lozenges may provide some relief for older children or teens. Do not give them to younger children, as they are a choking hazard.
Rest and activity
Your child does not need to stay in bed or be kept alone. She can choose how much rest she needs. Usually children slow down when they have a fever then become more active again.
Children can go back to school when the fever is gone and they can swallow normally. Most children will want to be back to their normal routine in 2 to 4 weeks.
Contact sports and other activities that might result in abdominal injury should be avoided if the spleen is enlarged. Check with your child's doctor.
How to reduce the spread of the virus or infection
Mono is most contagious while your child has a fever. After the fever is gone, the virus is still carried in the saliva in small amounts for up to 6 months. Your child with mono does not need to be kept alone. Avoid spreading the virus by using separate drinking glasses and utensils. Also, avoid kissing until the fever has been gone for several days.
The incubation period for mono is 4 to 10 weeks after contact with an infected person. This means that if your child is infected with the virus, she will not feel or appear sick until 4 to 10 weeks after contact.
When to seek medical assistance
Call your child’s regular doctor if:
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your child cannot drink enough fluids
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there is sinus or ear pain
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your child is not back to school after 2 weeks of being diagnosed with mono
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there are still symptoms after 4 weeks
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you have other questions or concerns
Take your child to the nearest Emergency Department if your child:
Key points
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Mono is a type of viral infection that can cause fever in young children.
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Teens and young adults with mono often have other symptoms with their fever.
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Keep your child comfortable and hydrated while her body fights the illness.
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Avoid sports and heavy lifting. Injury to the spleen can cause severe internal bleeding.