Clinical Reference Systems: Pediatric Advisor 10.0

Description

• severe sore throat
• large red tonsils covered with pus
• swollen lymph nodes in the neck, armpits, and groin
• fever for 7 to 14 days
• enlarged spleen (in 50% of children)
• blood smear showing many atypical (unusual) lymphocytes
• positive blood test for mononucleosis.

Cause

Mononucleosis (mono) is caused by the Epstein-Barr virus (EBV). This virus is transmitted in infected saliva through coughing, sneezing, and kissing. Although mononucleosis can occur at any age, it occurs more often in 15- to 25-year-olds, possibly because of more intimate contacts with others. Contrary to popular belief, mono is not very contagious. Even people in the same household rarely come down with it.

Reasons for Admission to the Hospital

Main complication: ________________________________________.

__ Needs IV fluids.

__ Needs IV antibiotic or other medication.

__ Other reasons: _________________________________________.

Expected Course

Most children have only mild symptoms for a week. Even those with severe symptoms usually feel completely well in 2 to 4 weeks.

Complications are rare and require hospitalization when they occur. The most common complication is dehydration from not drinking enough fluids. Breathing may be obstructed by enlarged tonsils, adenoids, and other lymph tissue in the back of the throat. On rare occasions, the enlarged spleen will rupture if the abdomen is hit or strained. Because over 90% of youngsters with mononucleosis will develop a severe rash if they take ampicillin or amoxicillin, these medications should be avoided in this condition.

Requirements for Discharge

• _______________________________________________________
• _______________________________________________________
• _______________________________________________________

Discharge Instructions for Home Treatment

1. Fever and pain medicines

   No specific medicine will cure mononucleosis. However, symptoms can usually be helped with medicines. The pain of swollen lymph nodes and fever over 102ƒF (39ƒC) can usually be relieved by appropriate doses of acetaminophen or ibuprofen.

2. Sore throat treatment

   Children over age 1 can sip warm chicken broth. Children over age 4 can suck on hard candy (butterscotch seems to be a soothing flavor). Because swollen tonsils can make some foods hard to swallow, provide a soft diet as long as necessary. To prevent dehydration, be sure that your youngster drinks enough fluids. Milk shakes and cold drinks are especially good. Avoid citrus fruits. Give a daily multiple vitamin pill until the appetite returns to normal. Again, acetaminophen or ibuprofen can be very helpful.

3. Activity

   Your child does not need to stay in bed. Bed rest will not shorten the course of the illness or reduce symptoms. Your child can select how much rest he or she needs. Usually children voluntarily slow down until they no longer have a fever. Children can return to school when the fever is gone and they can swallow normally. Most children will want to be back to full activity in 2 to 4 weeks.

4. Precautions for an enlarged spleen

   Your child's spleen may be enlarged while he or she has mononucleosis. A blow to the abdomen could rupture the enlarged spleen and cause bleeding. This is a surgical emergency. Therefore, all children with mononucleosis should avoid contact sports for at least 4 weeks. Athletes especially must restrict their activity until the spleen returns to normal size (as determined by a physical exam).

   Constipation and heavy lifting should also be avoided because of the sudden pressures they can put on the spleen.

   Your physician will check your child weekly until the spleen size returns to normal.

5. Contagiousness

   Infectious mononucleosis is most contagious while your child has a fever. After the fever is gone, the virus is still carried in the saliva for up to 6 months, but in small amounts. Overall, mononucleosis is only slightly contagious from contacts. Boyfriends, girlfriends, roommates, and relatives rarely get it. The person with mononucleosis does not need to be isolated. However, he or she should use separate drinking glasses and utensils and avoid kissing until the fever has been gone for several days.

   The incubation period for mononucleosis is 4 to 10 weeks after contact with an infected person. This means that if a person does become infected with the virus, the symptoms will not appear until 4 to 10 weeks after the contact.

6. Other medicines
   • For pain or fever over 102ƒF (39ƒC) give _______________________
   • ______________________________________________________
   • ______________________________________________________

7. Additional instructions

   _________________________________________________________

   _________________________________________________________

   _________________________________________________________

Follow-Up Appointment after Discharge

___ Your child needs to be rechecked and has an appointment on _____________ at _______ with _________________________.

___ Your child needs to be rechecked in ________ days. Call your child's doctor to make an appointment.

___ A follow-up appointment is not necessary. Call your doctor if you have any concerns.

Call your child's physician IMMEDIATELY if:

• Breathing becomes difficult or noisy.
• Signs of dehydration occur.
• Abdominal pain occurs (especially high on your child's left side).
• Your child starts acting very sick.

Call your child's physician within 24 hours if:

• Your child can't drink enough fluids.
• Sinus or ear pain occurs.
• Your child isn't back to school by 2 weeks.
• Any symptoms remain after 4 weeks.
• You have other questions or concerns.