What is the recommended treatment for young children with infectious mononucleosis (mono)?

Treatment for Young Children with Infectious Mononucleosis (Mono)

The recommended treatment for young children with infectious mononucleosis is primarily supportive care, as there is no specific antiviral therapy indicated for routine treatment of mono in pediatric patients. 1, 2

Diagnosis and Clinical Presentation

• Infectious mononucleosis is caused by the Epstein-Barr virus (EBV), which is transmitted primarily through saliva 3
• Primary EBV infection in children under 10 years is usually asymptomatic or presents with nonspecific symptoms 3
• When symptomatic, children may present with:
  • Sore throat
  • Mild fever
  • Swollen lymph nodes (particularly in the neck)
  • Hepatitis and spleen enlargement in some cases 3, 2
• Diagnostic testing may include:
  • Complete blood count with differential (looking for >40% lymphocytes and >10% atypical lymphocytes)
  • Heterophile antibody test (note: may be falsely negative in children under 5 years) 1
  • EBV viral capsid antigen-antibody testing (more sensitive but more expensive) 1

Recommended Treatment Approach

First-Line Management (Supportive Care)

• Ensure adequate hydration 4
• Provide appropriate analgesics and antipyretics for symptom relief 1, 4
• Allow for adequate rest, guided by the child's energy level (bed rest should not be enforced) 4
• Monitor for potential complications, particularly in very young children 2

What to Avoid

• Routine use of antivirals (such as acyclovir) is not recommended 1, 4
• Routine use of corticosteroids is not recommended and may lead to complications 1, 5
• Antihistamines are not recommended for routine treatment 4

Special Considerations

• Corticosteroids should be reserved only for severe cases with specific complications:
  • Impending airway obstruction
  • Severe hematological complications 5
• Prolonged steroid therapy should be avoided as it may lead to severe complications including:
  • Increased risk of secondary infections
  • Decompensated septic shock
  • Other serious complications 5

Activity Restrictions

• Children should be withdrawn from contact or collision sports for at least 4 weeks after symptom onset due to risk of splenic rupture 1, 4
• Return to normal activities should be guided by the child's energy levels 4

Monitoring and Follow-up

• Monitor for potential complications, which may include:
  • Splenic rupture
  • Acute upper airway obstruction
  • Hepatitis
  • Acute renal failure
  • Hematological and neurological complications 5
• Parents should be counseled that fatigue, myalgias, and increased need for sleep may persist for several months after the acute infection has resolved 4

Prognosis

• Infectious mononucleosis is typically a self-limiting disease in children 3
• Symptoms usually subside after a few weeks, though protracted courses can occur 3
• Long-term consequences are rare in children but have been linked to conditions such as Hodgkin lymphoma and multiple sclerosis in later life 2