Management of Mumps in Children
The management of mumps in children is primarily supportive, focusing on symptom relief including analgesics for pain, adequate hydration, and warm or cold compresses for parotid pain and swelling, as there is no specific antiviral therapy available. 1
Clinical Presentation and Diagnosis
Mumps presents with characteristic features:
- Parotid gland swelling (unilateral or bilateral)
- Fever, headache, malaise, and myalgia
- Only 30-40% of infections produce typical acute parotitis; 15-20% are asymptomatic 2
- Up to 50% of infections may present with nonspecific or primarily respiratory symptoms 2
Laboratory Diagnosis
- Optimal specimens include:
- Buccal/oral swab from parotid duct (collect within 3 days of symptom onset)
- Serum for mumps IgM antibodies
- Paired acute and convalescent serum samples to demonstrate 4-fold rise in mumps IgG 1
Management Approach
Supportive Care
- Analgesics (acetaminophen or ibuprofen) for pain and fever
- Adequate hydration
- Warm or cold compresses for parotid pain and swelling
- Soft, bland diet to minimize pain with chewing 1
Isolation Measures
- Isolate infected children for 5 days after parotid swelling onset
- Patients are most infectious from 2 days before to 5 days after parotid swelling begins 1
- Proper isolation is critical to prevent widespread outbreaks 3
Management of Complications
Complications requiring specific management include:
Aseptic Meningitis (occurs in 4-6% of cases) 2
- Usually mild and self-limiting
- Monitor for headache, neck stiffness, and photophobia
- May require hospitalization for severe cases
Orchitis (in postpubertal males)
Pancreatitis
- Monitor for abdominal pain, nausea, and vomiting
- May require hospitalization for severe cases 4
Sensorineural Hearing Loss
- Can be sudden in onset, bilateral, and permanent
- Audiological evaluation for suspected cases 2
Prevention
- MMR (measles, mumps, rubella) vaccination is the most effective preventive measure 1
- Children should receive:
- First dose at 12-15 months of age
- Second dose at 4-6 years of age 2
- During outbreaks, additional vaccination may be considered for susceptible individuals 2
Special Considerations
- Immunocompromised Children: Require closer monitoring for complications 1
- Pregnancy: Mumps during first trimester carries increased risk of fetal death, though not associated with congenital malformations 1
- Reporting: Mumps is a reportable disease in most states - notify local public health authorities of suspected cases 3
Common Pitfalls to Avoid
- Failing to recognize mumps in vaccinated children (breakthrough infections can occur)
- Delaying isolation measures, which can lead to outbreaks
- Missing complications that can occur without parotitis
- Inadequate specimen collection for laboratory confirmation
- Not reporting cases to public health authorities
Remember that mumps is highly contagious, and early recognition with proper isolation is crucial to prevent transmission, especially in settings where children congregate 1, 3.