Mononucleosis: A Guide for Parents

As a pediatrician, I understand that any illness affecting your child can be concerning. Today, we’ll review mononucleosis, often called "mono" or the "kissing disease." While it's a common illness, especially in teenagers and young adults, understanding its basics can help you recognize it, know when to seek care, and support your child through it.

Mononucleosis is primarily caused by the Epstein-Barr virus (EBV), a very common virus that most people will be exposed to at some point in their lives.

What Symptoms Should You Look For?

The symptoms of mononucleosis can vary from person to person.

Many infants and young children infected with EBV have no symptoms at all or only mild symptoms.

Adolescents and young adults are more likely to exhibit symptoms when infected with EBV.  The classic symptoms of mono include:

• Fever: A moderate to high fever is common, especially in the initial stages of the illness.  This is often accompanied by headache and body aches.
• Sore Throat: The sore throat associated with mono can be severe and cause swallowing to be painful.  Mono will often cause redness of the throat and white patches on the tonsils.
• Swollen Lymph Nodes: You might notice enlarged and tender lymph nodes, particularly in the neck. These swollen glands can sometimes be quite noticeable and typically take a few weeks to resolve.
• Fatigue: This symptom can last for several months, persisting after other symptoms have subsided. Your child may feel unusually tired, even after resting.

Other signs and symptoms that can be seen with mono:

• Swollen Spleen: The spleen, an organ in the upper left abdomen, can become enlarged in some individuals with mono. This enlargement usually isn't painful but can make the spleen more vulnerable to injury.
• Skin Rash: Some individuals, particularly those who are given certain antibiotics like ampicillin or amoxicillin, may develop a rash.
• Swelling around the eyes

It's important to note that not everyone with mono will experience all of these symptoms. The presentation can be quite variable.

Diagnosis

During a visit, your pediatrician will ask about your child's symptoms, perform a physical exam (paying close attention to the throat, lymph nodes, and abdomen), and may order blood tests to confirm the diagnosis. These tests often include a Monospot test or blood work to look for antibodies specific to the Epstein-Barr virus.

Treatment

The mainstay of treatment for mono is supportive care.  Rest is crucial for recovery, along with staying hydrated and managing symptoms like fever and sore throat with over-the-counter medications such as acetaminophen and ibuprofen.

Avoid sports while the spleen is enlarged to prevent the risk of rupture.  Individuals should not participate in any sports for at least 3 weeks from the onset of symptoms.  They should refrain from strenuous or contact sports for at least 4 weeks.

When Should You Seek Medical Care?

While many cases of mono resolve with rest and supportive care at home, there are certain situations when it's crucial to seek medical attention for your child:

• Severe Sore Throat: If your child's sore throat is so painful that it's difficult to swallow liquids or breathe comfortably.
• Difficulty Breathing or Shortness of Breath: This could indicate a more serious complication.
• Severe Abdominal Pain: This could be a sign of a significantly enlarged or potentially ruptured spleen, which requires immediate medical attention.
• Prolonged High Fever: Fever can be prolonged with mono infection, however it is recommended to get evaluated by your doctor if the fever is lasting longer than 5 days to ensure no complications have developed.
• Signs of Dehydration: Reduced urination, dizziness upon standing, and dry mouth can indicate dehydration, which may require intravenous fluids.
• Jaundice: Yellowing of the skin or eyes is not typical of mono and needs to be evaluated.
• Significant Weakness or Neurological Symptoms: Any unusual weakness, numbness, or other neurological changes should be checked promptly.

Prevention: What Can You Do?

EBV is commonly spread through close contact with saliva, which is why it's sometimes called the "kissing disease." However, it's important to remember that it can also be spread through sharing drinks, utensils, or other personal items.

General hygiene practices can help reduce the risk of transmission:

• Avoid Sharing: Encourage your child not to share drinks, food, utensils, toothbrushes, or anything else that comes into contact with saliva.
• Good Handwashing: Frequent and thorough handwashing is always a good way to prevent the spread of various infections.
• Avoid Close Contact with Sick Individuals: While it's not always possible, try to limit close contact with individuals who have active symptoms of illness.

Once someone has been infected with EBV, they typically develop lifelong immunity and won't get mononucleosis again.

Navigating mononucleosis can be challenging for both your child and your family.

Please don't hesitate to reach out to our office if you have any concerns about your child's health. We are here to support you and your family through this and any other health challenges. With proper care and rest, your child will be back to their usual energetic self.