What is the best approach to manage parotid gland swelling in a pediatric patient with mumps?

Management of Parotid Gland Swelling in Pediatric Mumps

Mumps in children requires supportive care only—provide acetaminophen or NSAIDs for pain and fever control, ensure adequate hydration with soft foods, implement strict 5-day isolation with droplet precautions, and monitor vigilantly for potentially serious complications including meningitis, encephalitis, and hearing loss. 1

Immediate Symptomatic Management

The cornerstone of mumps treatment is supportive care, as no specific antiviral therapy exists for this self-limiting viral illness 1, 2:

• Administer acetaminophen or NSAIDs to control fever, headache, and parotid gland pain 1
• Ensure adequate fluid intake since parotitis makes swallowing uncomfortable and painful 1
• Recommend soft, bland foods and specifically avoid acidic foods that stimulate salivary flow and worsen parotid pain 1

Critical Isolation Protocol

Implement droplet precautions immediately upon suspicion of mumps, as patients are contagious from 7 days before through 8 days after parotitis onset 3, 1:

• Isolate the patient for 5 days after onset of parotid swelling 1
• Educate family members about transmission through respiratory droplets and direct contact with saliva 1
• Report all probable or confirmed cases immediately to state and local health departments 1

Vigilant Complication Monitoring

While mumps is generally self-limiting, complications can be serious and require heightened surveillance 1, 2:

Neurological Complications

• Monitor for aseptic meningitis (occurs in 4-6% of cases): severe headache, neck stiffness, photophobia, or altered mental status 3, 1
• Assess for encephalitis signs: seizures, paralysis, or cranial nerve palsies that can cause permanent sequelae 1, 4

Hearing Loss

• Watch for sudden sensorineural deafness, which can be bilateral and permanent—mumps was a major cause of childhood deafness in the pre-vaccine era 1, 4

Gonadal Involvement

• In postpubertal males, assess for orchitis (occurs in up to 38% of cases): testicular pain and swelling, though sterility is rare 3, 1, 4
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 3, 1

Other Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1, 4
• Be alert for laryngeal edema, a rare but potentially life-threatening complication requiring emergency airway management 5

Special Management for Facial Nerve Involvement

If facial droop or weakness develops 1:

• 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 patients that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Critical Clinical Caveats

Diagnostic Pitfalls

• 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 1, 4, 2
• Laboratory confirmation is preferred over clinical diagnosis alone, as parotitis has multiple infectious and noninfectious causes 1
• Laboratory criteria include: isolation of mumps virus from clinical specimens, significant rise in serum mumps IgG antibody, or positive serologic test for mumps IgM antibody 1

Diagnostic Testing Recommendations

• Obtain parotid duct swab following parotid massage or buccal swab for mumps PCR/culture within 9 days of symptom onset 3
• Send CSF for mumps PCR if neurological complications are suspected 3
• Consider throat and rectal swabs for enterovirus investigations to rule out alternative diagnoses 3

Important Warnings

• Do NOT administer mumps vaccine to pregnant women due to theoretical risk of fetal harm from live-virus vaccine 1, 6
• Do NOT assume immunity based on vaccination alone—recent outbreaks have occurred in highly vaccinated populations, particularly among young adults in college settings 1, 2
• Do NOT overlook complications in patients without parotitis—serious complications can occur without evidence of parotid swelling 1

Prognosis and Recovery

Mumps disease is generally self-limiting, with most patients recovering without intervention beyond supportive care 1, 2. The virus has been isolated from saliva from 7 days before through 8 days after onset of salivary gland swelling 3.