What is the treatment and management approach for mumps in children?

Treatment and Management of Mumps in Children

Mumps in children is managed primarily with supportive care focused on symptomatic relief, strict isolation precautions, and vigilant monitoring for complications—there is no specific antiviral treatment available.

Primary Symptomatic Management

The cornerstone of treatment is symptomatic relief using acetaminophen or NSAIDs for fever control, headache, and parotid gland pain. 1 This addresses the primary discomfort children experience during acute infection.

Supportive Care Measures

• Ensure adequate fluid intake, as parotid swelling makes swallowing uncomfortable and children may become dehydrated 1
• Offer soft foods that require minimal chewing to reduce pain during eating 1
• Apply warm or cold compresses to swollen parotid glands for comfort (general medical practice)

Isolation and Infection Control

Implement strict droplet precautions immediately upon diagnosis, as patients are contagious from 7 days before through 8 days after parotitis onset. 1 This is critical for preventing transmission to susceptible individuals.

Specific Isolation Requirements

• Maintain respiratory isolation for 9 days after symptom onset (e.g., after parotitis begins) 2
• Exclude infected children from school or daycare for the full 9-day period after parotitis onset 2
• Educate family members about transmission through respiratory droplets and direct contact with saliva to prevent household spread 1

Monitoring for Complications

Vigilant surveillance for complications is essential, as mumps can cause significant morbidity despite being typically self-limited. The following complications require specific monitoring:

Neurological Complications

• Aseptic meningitis occurs in 4-6% of clinical cases—monitor for severe headache, neck stiffness, photophobia, or altered mental status 1
• Watch for signs of encephalitis including seizures, paralysis, or cranial nerve palsies, though this is rare 1
• Be aware of potential sudden sensorineural hearing loss, which can be permanent though uncommon 1

Reproductive System Complications

• In postpubertal males, assess for orchitis characterized by testicular pain and swelling—this occurs in approximately 3.8% of males over age 12 1, 3
• Orchitis typically develops 4-8 days after parotitis onset (general medical knowledge)

Gastrointestinal Complications

• Monitor for pancreatitis characterized by severe abdominal pain, nausea, and vomiting 1

Diagnostic Confirmation

Laboratory confirmation is essential, as clinical diagnosis alone is unreliable—approximately one-third of clinically diagnosed mumps cases lack serologic evidence of actual mumps infection. 2, 4

Laboratory Testing Approach

• Obtain mumps IgM antibody testing as the primary confirmatory test 2, 4
• Consider viral isolation from parotid duct swabs or PCR from appropriate specimens 4
• Acute and convalescent IgG titers showing significant rise can confirm diagnosis 2, 4
• Report all probable or confirmed cases immediately to state and local health departments 2

Vaccination Status Review

Review the child's MMR vaccination history, noting that two-dose MMR vaccine effectiveness is approximately 88% against mumps 1. This explains why breakthrough infections occur even in vaccinated populations.

Key Vaccination Points

• Most children should have received two MMR doses by age 10 1
• Vaccination status inversely correlates with disease severity—vaccinated children typically experience milder illness and fewer complications 3
• Previous vaccination reduces complication risk by approximately 52-63% depending on number of doses received 3

Common Pitfalls to Avoid

• Do not rely solely on clinical diagnosis—parotitis has multiple infectious and noninfectious causes including EBV, CMV, HIV, and other viruses 2, 4
• Do not assume immunity based on vaccination alone—breakthrough infections occur, particularly in outbreak settings 5, 3
• Do not discharge without clear return precautions for neurological symptoms, severe abdominal pain, or testicular pain in males 1
• Do not forget to identify and follow up susceptible contacts who may require post-exposure vaccination 2