Clinical Reference Systems: Pediatric Advisor 10.0
DESCRIPTION (Diagnosis must be confirmed by a physician.)
- 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)
- positive blood test for mononucleosis.
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.
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.
CHRONIC FATIGUE SYNDROME
The symptoms of chronic fatigue syndrome are fatigue,
tiredness, weakness, recurrent pains, and the need for more
sleep. The symptoms are present for at least 6 months.
There is no good scientific evidence to support mononucleosis
as the cause of chronic fatigue syndrome. In general
mononucleosis neither lingers nor gets worse. All symptoms
are gone within 4 weeks after they first appear. In fact,
recent evidence points to a retrovirus as the cause of
chronic fatigue syndrome.
Lab tests of the saliva of people who have chronic fatigue
syndrome have found the Epstein-Barr virus in the saliva.
Tests of their blood have detected antibodies to this virus.
These lab results have caused some confusion about the cause
of chronic fatigue syndrome. However, 10% to 20% of healthy
adults who had mono in the past have the Epstein-Barr virus
in their saliva because the virus periodically reappears
without any symptoms. Also, the number of mononucleosis
antibodies in the blood increases when a person gets new
infections by other viruses. Neither the presence of EBV in
saliva nor mononucleosis antibodies in the blood means that
a person has mononucleosis again.
HOME TREATMENT FOR MONONUCLEOSIS
- 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 102 degrees F
(39 degrees C) can usually be relieved by appropriate
doses of acetaminophen or ibuprofen.
- Sore throat treatment
Children over age 1 can sip on 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.
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.
- 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
Constipation and heavy lifting should also be avoided
because of the sudden pressures they can put on the
Your physician will check your child weekly until the
spleen size returns to normal.
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
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
- 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.