What is the treatment for a child or young adult diagnosed with acute parotitis (mumps)?

Treatment of Acute Parotitis (Mumps) in Children and Young Adults

The treatment of acute mumps parotitis is entirely supportive, focusing on symptom management with acetaminophen or NSAIDs for pain and fever control, adequate hydration, and isolation for 5 days after parotitis onset. 1

Primary Symptomatic Management

The cornerstone of mumps treatment is supportive care, as this is a self-limiting viral illness with no specific antiviral therapy:

• Provide acetaminophen or NSAIDs to control fever, headache, and parotid gland pain 1
• Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful 1
• Recommend soft foods and avoidance of acidic foods that may stimulate salivary flow and worsen parotid pain 1

The CDC emphasizes that mumps disease is generally self-limiting, with most patients recovering without intervention beyond these supportive measures 1

Mandatory Isolation Requirements

Infection control is critical to prevent transmission:

• Implement droplet precautions immediately, as patients are contagious from 7 days before through 8 days after parotitis onset 1
• Isolate for 5 days after onset of parotitis to limit spread to susceptible contacts 1, 2
• Educate patients and family members about transmission through respiratory droplets and direct contact with saliva 1

Note that the isolation period was updated from 9 days to 5 days in 2008 after review by the Healthcare Infection Control Practices Advisory Committee, based on evidence of mumps viral load and transmission patterns 2

Active Monitoring for Complications

While most cases resolve without sequelae, complications are more common and severe in adults than children, requiring vigilant monitoring 1:

Neurological Complications

• Monitor for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 1
• Watch for encephalitis signs: seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae 1
• Assess for hearing loss, including sudden sensorineural deafness, which was a major cause of childhood deafness in the pre-vaccine era 1

Reproductive System Complications

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling, though sterility is rare 1
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1

Other Systemic Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1

Special Management: Facial Nerve Involvement

If facial nerve inflammation develops (a rare complication):

• Initiate corticosteroid therapy promptly with prednisone 1-2 mg/kg/day for 5-7 days followed by a taper over 5-7 days to reduce inflammation and improve nerve function 1
• Provide eye protection to prevent corneal damage in patients with facial weakness 1
• Reassure patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Critical Clinical Caveats

Diagnostic Considerations

• Parotitis is not always present—only 30-40% of mumps infections produce typical acute parotitis, while 15-20% are asymptomatic and up to 50% present with nonspecific or respiratory symptoms 3, 1
• Laboratory confirmation is strongly preferred over clinical diagnosis alone, as one study found that one-third of persons with clinically diagnosed mumps had no serologic evidence of recent mumps infection 3
• Confirm diagnosis with: virus isolation from clinical specimens, significant rise in serum mumps IgG antibody titers between acute and convalescent phases, or positive mumps IgM antibody testing 3

Age-Related Risk Stratification

• Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1
• Parotitis occurs most commonly among children aged 2-9 years, while inapparent infection may be more common among adults 3

Common Pitfall to Avoid

Do not assume all acute parotitis is mumps—other infectious causes (including influenza A) and noninfectious etiologies can present identically, particularly in vaccinated populations 4. Always pursue laboratory confirmation when feasible.