What is the management and treatment for a pediatric patient with mumps?

Management of Mumps in Pediatric Patients

Mumps in children is managed primarily with symptomatic care including acetaminophen or NSAIDs for pain and fever control, adequate hydration, and strict isolation for 5 days after parotitis onset, while vigilantly monitoring for complications such as aseptic meningitis, orchitis in postpubertal males, and hearing loss. 1, 2

Primary Symptomatic Treatment

The cornerstone of mumps management is supportive care, as there is no specific antiviral therapy available 3:

• Administer acetaminophen or NSAIDs to control fever, headache, and parotid gland pain 1, 2
• Ensure adequate fluid intake, as parotitis makes swallowing uncomfortable and painful 1, 2
• Recommend soft foods and avoid acidic foods that stimulate salivary flow and worsen parotid pain 1

Isolation and Infection Control

Immediate implementation of infection control measures is critical to prevent transmission:

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

Monitoring for Complications

Neurological Complications

Vigilant monitoring for CNS involvement is essential, as these complications can cause permanent sequelae:

• 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 neurological damage 4, 1
• Monitor for hearing loss, including sudden sensorineural deafness, which was a major cause of childhood deafness in the pre-vaccine era 1, 2

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, 2
• In postpubertal females, monitor for oophoritis (ovarian inflammation) 1

Gastrointestinal Complications

• Watch for pancreatitis: severe abdominal pain, nausea, and vomiting 1, 2

Special Consideration: Facial Nerve Involvement

If facial nerve inflammation develops with facial weakness:

• 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

Atypical Presentations

• 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
• Clinical diagnosis alone is unreliable and leads to misdiagnosis in approximately one-third of cases, making laboratory confirmation essential 5

Laboratory Confirmation

When mumps is suspected, obtain:

• Mumps-specific IgM antibody testing as the primary confirmatory test 5
• Viral PCR from parotid duct swabs obtained after massaging the parotid gland for 30 seconds, collected within 9 days of symptom onset 5
• Buccal (saliva) swabs for viral culture or PCR within 9 days of symptoms 5

Age-Related Considerations

• Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1
• Most patients recover without intervention beyond supportive care, as mumps disease is generally self-limiting 1

Vaccination Context

• Review the child's vaccination history: a fully vaccinated child should have received two doses of MMR vaccine, with vaccine effectiveness approximately 88% 2
• Mumps can still occur in vaccinated populations, as demonstrated by outbreaks in highly vaccinated college students with two-dose coverage of 90% 6