Pediatric Treatment for Mumps
Primary Treatment Approach
Mumps treatment in children is entirely supportive—there is no antiviral therapy or specific medical intervention that changes the disease course. 1, 2 The American Academy of Pediatrics and CDC recommend focusing on symptom control, strict isolation, and vigilant monitoring for complications. 1
Symptomatic Management
- Administer acetaminophen or NSAIDs for pain and fever control to manage fever, headache, and parotid gland pain. 1, 2
- Ensure adequate hydration and fluid intake, as parotitis makes swallowing uncomfortable and painful. 1, 2
- Recommend soft foods and avoid acidic foods that may stimulate salivary flow and worsen parotid pain. 1
Critical Isolation Requirements
Implement droplet precautions immediately and isolate the child for 5 days after onset of parotitis, as patients are contagious from 7 days before through 8 days after parotitis onset. 1, 2 This isolation period is non-negotiable to prevent transmission to susceptible contacts.
- Educate family members about transmission through respiratory droplets and direct contact with saliva. 1, 2
- Report probable or confirmed cases immediately to state and local health departments. 1
Monitoring for Complications
While complications are significantly more common in adults than children, vigilant monitoring remains essential in pediatric patients. 3, 1
Neurological Complications
- Watch for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status. 1, 2
- Assess for encephalitis signs: seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae including paralysis, aqueductal stenosis, and hydrocephalus. 3, 1
- Monitor for hearing loss: sudden sensorineural deafness can be bilateral and permanent—mumps was a major cause of childhood deafness in the pre-vaccine era. 3, 1, 2
Other Complications
- In postpubertal males, assess for orchitis: testicular pain and swelling (occurs in up to 38% of postpubertal males, though sterility is rare). 3, 1, 2
- Watch for pancreatitis: severe abdominal pain, nausea, and vomiting. 1, 2
Special Management for Facial Nerve Involvement
If facial droop or weakness develops, 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 if facial weakness prevents complete eye closure. 1
- Reassure families that complete recovery occurs in approximately 70-80% of cases within 3-6 months. 1
Critical Clinical Caveats
Parotitis is NOT present in all cases—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 This means you cannot rule out mumps based on absence of parotid swelling alone.
- Serious complications can occur without evidence of parotitis, so maintain clinical suspicion even in atypical presentations. 3, 1
- Mumps disease is generally self-limiting, with most patients recovering without intervention beyond supportive care. 1, 4, 5
- Laboratory confirmation is preferred over clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes. 1
Common Pitfalls to Avoid
- Do not assume immunity based on vaccination alone—recent outbreaks have occurred in highly vaccinated populations, particularly among young adults in college settings, with vaccine effectiveness approximately 88%. 1, 2, 4
- Do not overlook complications in patients without parotitis—serious complications including meningitis, encephalitis, and deafness can occur without parotid swelling. 1
- Do not delay isolation measures—patients are contagious before parotitis develops (7 days before onset), making early recognition and isolation crucial. 1, 2