What is the recommended management for mumps in a pediatric patient?

Management of Mumps in Pediatric Patients

Mumps management in children is primarily supportive, focusing on symptomatic relief with acetaminophen or NSAIDs for pain and fever control, adequate hydration, and strict isolation for 5 days after parotitis onset, while vigilantly monitoring for complications including aseptic meningitis, orchitis in postpubertal males, and pancreatitis. 1, 2

Primary Symptomatic Care

• Provide pain and fever control using acetaminophen or NSAIDs to manage 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 advise avoidance of acidic foods that stimulate salivary flow and worsen parotid pain 1
• No specific antiviral therapy exists for mumps—treatment remains entirely supportive 3, 4

Isolation and Infection Control

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

Vigilant Monitoring for Complications

Neurological Complications

• Monitor for aseptic meningitis (occurs in 4-6% of cases), characterized by severe headache, neck stiffness, photophobia, or altered mental status 1, 2
• Watch for encephalitis signs including seizures, paralysis, or cranial nerve palsies, which can cause permanent sequelae 1, 2
• Assess for hearing loss, including sudden sensorineural deafness, which was historically a major cause of childhood deafness in the pre-vaccine era 1, 2

Reproductive System Complications

• Assess postpubertal males for orchitis (occurs in up to 38% of cases), characterized by testicular pain and swelling, though sterility is rare 1, 2, 4
• Monitor postpubertal females for oophoritis (ovarian inflammation) 1

Other Systemic Complications

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

Special Consideration: Facial Nerve Involvement

If facial nerve inflammation 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 in patients with facial weakness 1
• Reassure families that complete recovery occurs in approximately 70-80% of cases within 3-6 months 1

Diagnostic Confirmation

When mumps encephalitis is suspected:

• CSF PCR is the most accurate confirmatory test for mumps encephalitis 5
• Parotid gland duct swabs (after massaging the parotid gland for 30 seconds) or buccal swabs should be sent for viral culture or PCR within 9 days of symptom onset 5
• Serum or salivary mumps antibodies are also helpful for diagnosis 5
• Urine samples are less sensitive but may be positive for at least 5 days after detection in the mouth 5

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 1
• Complications are more common and severe in adults than children, making age an important consideration in monitoring intensity 1, 4
• Most patients recover without intervention beyond supportive care, as mumps disease is generally self-limiting 1
• Review vaccination history: A 10-year-old should have received two doses of MMR vaccine, with vaccine effectiveness approximately 88% 2
• Post-exposure MMR vaccination does not prevent or alter clinical severity of mumps, unlike measles 6