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: Infectious mononucleosis or "mono" in children

DEAR DR.PAUL: My 10-year-old daughter developed mono a few weeks ago, and it has made her really tired. I was very surprised that mono occurs in children, I thought it was an adult disease. Is it common in children? Thanks.

PEDIATRICIAN DR.PAUL Answers: Your reaction is the one I usually get when I tell them their child has mono.

The actual medical term for "mono" is Infectious Mononucleosis, and it is caused by the Epstein Barr virus. Though most of us associate mono with teens and adults, it can infect children of all ages, in fact, in poorer countries the average age of infection is two to four years of age.

In North America, most cases occur in adolescents and early adulthood, but we can see mono at all ages.

The symptoms and signs of mono are quite specific, but in younger children it can look like a cold. Often, we do not make an immediate diagnosis because the symptoms mimic those of another viral infection. Diagnosis is confirmed by a specific blood test.

The typical symptoms of mono include a period of a week or two of fever, feeling tired, and a very sore throat. Other typical signs of mono are enlarged glands in the neck region, a rash all over the body, and, less frequently, swelling around the eyes. When we examine children with possible mono, we find a tired-looking child, with very large (often whitish) tonsils, and swollen glands around the neck. Up to 50% of children with mono will develop an enlarged spleen.

One of the most common complications of mono is not being able to swallow due to the very sore throat. Obviously, we recommend drinking as much fluid as possible, but avoiding fruit juices as these may hurt the already sore throat. As a matter of fact, milk shakes are a great idea in children with a very sore throat. In extreme cases, when children cannot drink enough, they can become dehydrated and require hospitalization so they can receive fluids intravenously.

The symptoms of mono typically persist for a two-to-three week period and the fatigue can linger for up to one or two months.

There is no specific treatment, for mono as long as the child is drinking adequately. Young adults or adolescents with mono are typically very tired and will need to rest in bed. Usually, they will have little energy to do much else. As time goes by, they become more energetic and can return to normal activities depending on how they feel. One important point to keep in mind is that an enlarged spleen can be easily damaged during physical activity. This is important because a ruptured spleen can be fatal. For this reason, children with a mono-related enlarged spleen should not partake in any exercise or physical (contact) activity, even if they're feeling better.

When your child is feeling better, she should be re-assessed by your doctor. If the spleen size has returned to normal, physical exercise/activity can resume.

On a final note, mono is spread through the saliva. This is why it is known as the "Kisser's Disease." However, most commonly, it spreads by close contact or sharing kitchen and other utensils with an infected individual.

The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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