Mumps in Children: Comprehensive Nursing Management
A complete guide for nursing students on identification, diagnosis, management, and prevention
Table of Contents
1. Introduction to Mumps
Mumps is a contagious viral infection primarily affecting the parotid glands. It is caused by the mumps virus, a member of the Paramyxoviridae family. Before widespread vaccination, mumps was a common childhood disease worldwide, with peak incidence during winter and spring months.
Mumps predominantly affects children aged 5-14 years, though individuals of any age can contract the disease if not immune. The mumps virus spreads through respiratory droplets or direct contact with an infected person’s saliva. The condition is characterized by painful swelling of one or both parotid glands, fever, and general malaise.
Historical Significance: Prior to the introduction of the mumps vaccine in 1967, nearly everyone contracted mumps during childhood. Today, mumps outbreaks still occur, particularly in settings where people have close, prolonged contact, such as schools and colleges.
As a nurse caring for children with mumps, understanding the disease process, recognizing symptoms early, implementing appropriate nursing interventions, and educating families on prevention are essential components of comprehensive care.
2. Pathophysiology
Entry & Replication
Respiratory epithelium
Viremia
Bloodstream spread
Target Tissues
Parotid & other glands
Inflammatory Response
Glandular swelling
The mumps virus is a single-stranded RNA virus belonging to the Paramyxoviridae family. Understanding the pathophysiology of mumps involves tracing the virus’s journey from infection to manifestation:
- Transmission: The mumps virus primarily enters the body through the respiratory tract via inhalation of respiratory droplets or direct contact with infected saliva.
- Incubation Period: After exposure, the virus undergoes an incubation period of 16-18 days (range: 12-25 days), during which it replicates in the upper respiratory tract epithelium.
- Viremia: The virus enters the bloodstream (primary viremia), allowing for systemic distribution. During this phase, the infected individual is contagious, typically from 2 days before to 5 days after the onset of parotid swelling.
- Target Tissue Invasion: The mumps virus has tropism for glandular tissue, particularly the salivary glands (especially the parotid glands), and potentially the pancreas, testes, ovaries, brain, and meninges.
- Inflammatory Response: Viral replication in the glandular tissues triggers a local inflammatory response characterized by:
- Edema and cellular infiltration
- Ductal epithelial damage
- Interstitial inflammation
- Potential obstruction of salivary ducts
- Immune Response: The body mounts a humoral and cell-mediated immune response against the mumps virus, resulting in lifelong immunity after infection in most cases.
Key Point: The mumps virus has a particular affinity for glandular tissues, explaining why the parotid glands are primarily affected, but also why complications can occur in other glandular organs like the testes (orchitis), ovaries (oophoritis), and pancreas (pancreatitis).
3. Clinical Manifestations
The clinical manifestations of mumps typically progress through three distinct phases: prodromal, acute, and resolution. About 20-30% of mumps infections may be asymptomatic, but when symptoms occur, they follow a characteristic pattern:
3.1 Prodromal Phase
The prodromal phase typically lasts 1-2 days and includes non-specific symptoms:
- Low-grade fever (38-39°C)
- Malaise and fatigue
- Myalgia (muscle pain)
- Headache
- Anorexia (loss of appetite)
- Mild respiratory symptoms
3.2 Acute Phase
The acute phase is characterized by the hallmark symptom of mumps—parotid gland swelling:
- Parotitis: Painful swelling of one or both parotid glands
- Initially unilateral in 25% of cases, becoming bilateral in 75% of cases within 1-5 days
- Reaches maximum size in 1-3 days
- Causes characteristic “hamster-like” facial appearance
- Pain worsens with jaw movement or acidic foods
- Other salivary gland involvement: Submandibular and sublingual glands may be affected in addition to or instead of the parotid glands
- Fever: May spike to 39-40°C during this phase
- Earache: Often referred from parotid inflammation
- Dry mouth due to decreased saliva production
- Difficulty chewing, swallowing, or talking due to pain
Clinical Pearls: When examining a child with suspected mumps, the “Stensen’s duct sign” may be present—the opening of the parotid (Stensen’s) duct appears red and swollen. Additionally, lifting the earlobe may exacerbate pain in parotitis, helping differentiate it from cervical lymphadenopathy.
3.3 Resolution Phase
The resolution phase typically begins 3-7 days after the onset of parotitis:
- Gradual reduction in parotid swelling
- Resolution of fever
- Improvement in pain and discomfort
- Complete resolution typically occurs within 7-10 days
| Clinical Feature | Characteristics | Nursing Implications |
|---|---|---|
| Parotitis | Tender, firm swelling in front of and below the ear; may obliterate the angle of the mandible | Monitor for bilateral involvement; assess pain level; provide pain management |
| Fever | Usually 38-39°C; may persist for 3-5 days | Monitor temperature q4h; provide antipyretics as prescribed; ensure adequate hydration |
| Pain | Localized to parotid region; exacerbated by chewing, swallowing | Administer analgesics; recommend soft diet; apply warm or cold compresses as tolerated |
| Difficulty eating | Due to pain with mastication and reduced salivary flow | Offer soft, bland foods; ensure adequate hydration; avoid acidic foods and beverages |
| Fatigue | General malaise and tiredness throughout illness | Encourage rest; modify activities based on energy level; promote adequate sleep |
4. Complications
While mumps is generally a self-limiting disease, complications can occur, particularly in adolescents and adults. These complications may develop even in the absence of parotitis and can significantly increase morbidity:
Mumps Complications by System
Reproductive System:
- Orchitis (testicular inflammation) – Occurs in 20-30% of post-pubertal males
- Oophoritis (ovarian inflammation) – Occurs in 5% of post-pubertal females
Nervous System:
- Aseptic Meningitis – Most common CNS complication (1-10%)
- Encephalitis – Rare but serious (0.1%)
- Hearing Loss – Can be permanent (1:20,000)
Digestive System:
- Pancreatitis – Occurs in about 4% of cases
Other Systems:
- Myocarditis – Uncommon
- Arthritis – Rare
- Nephritis – Rare
Red Flags for Complications
Nurses should be vigilant for the following warning signs that may indicate complications:
- Severe headache, neck stiffness, photophobia (meningitis)
- Altered mental status, seizures (encephalitis)
- Severe testicular pain, swelling, and redness (orchitis)
- Severe abdominal pain radiating to the back (pancreatitis)
- Hearing difficulties or tinnitus (sensorineural hearing loss)
Detailed Review of Key Complications
Orchitis
Orchitis is inflammation of the testes and is the most common complication in post-pubertal males with mumps. Key features include:
- Typically occurs 4-8 days after the onset of parotitis
- Characterized by sudden testicular pain, swelling, and erythema
- Often accompanied by fever, nausea, and vomiting
- Usually unilateral (70-75% of cases)
- May result in testicular atrophy in 30-50% of affected testes
- Rarely causes sterility, even with bilateral involvement
Aseptic Meningitis
Mumps virus has neurotropic properties and can cause aseptic meningitis, which is usually mild and self-limiting:
- May occur in the absence of parotitis in up to 50% of cases
- Presents with headache, neck stiffness, photophobia, and vomiting
- CSF analysis shows lymphocytic pleocytosis with normal glucose
- Typically resolves without sequelae within 3-10 days
Pancreatitis
Mumps pancreatitis presents with:
- Epigastric pain radiating to the back
- Nausea and vomiting
- Elevated serum amylase and lipase
- Usually mild and self-limiting
The risk of complications is significantly reduced in vaccinated individuals who develop breakthrough mumps, highlighting the importance of immunization in preventing severe disease.
5. Diagnosis and Assessment
The diagnosis of mumps is based on a combination of clinical presentation, epidemiological factors, and laboratory confirmation. Nurses play a crucial role in the assessment and identification of suspected mumps cases.
5.1 Diagnostic Tests
| Diagnostic Test | Specimen | Timing | Interpretation |
|---|---|---|---|
| RT-PCR | Buccal swab or oral fluid | 1-3 days after symptom onset (optimal); up to 9 days | Most sensitive method for detecting mumps virus RNA |
| Viral Culture | Buccal swab, throat swab, urine | First 3-4 days of symptoms | Positive culture confirms infection but may take 7-10 days for results |
| Serology (IgM) | Serum | 3-5 days after symptom onset; peaks at 7-10 days | Positive IgM indicates acute infection; may be negative in previously vaccinated individuals |
| Serology (IgG) | Serum | Paired sera: acute and 2-3 weeks later | 4-fold rise in IgG titer indicates recent infection |
| CSF Analysis | Cerebrospinal fluid | When neurological symptoms present | Lymphocytic pleocytosis, normal glucose, slightly elevated protein |
Nursing Consideration: When collecting specimens for mumps testing, ensure proper technique to maximize yield and minimize patient discomfort. For buccal swabs, massage the parotid gland area for about 30 seconds prior to collecting the specimen to increase viral shedding.
5.2 Differential Diagnosis
Several conditions can mimic mumps and should be considered in the differential diagnosis:
Bacterial Parotitis
- Usually unilateral and more severe
- Patient appears more toxic
- Often associated with dehydration
- Purulent exudate from Stensen’s duct
Cervical Lymphadenitis
- Swelling below angle of jaw, not in front of ear
- Discrete nodes palpable
- Often associated with pharyngitis
- Parotid function normal
Salivary Duct Obstruction
- Usually unilateral
- Swelling worsens during meals
- History of intermittent swelling
- No systemic symptoms
Other Viral Infections
- EBV (infectious mononucleosis)
- Parainfluenza virus
- Influenza A
- Coxsackievirus
Mnemonic: “MUMPS” for Diagnostic Assessment
- M – Massage parotid when collecting specimens
- U – Unilateral or bilateral swelling (document)
- M – Measure temperature and document fever pattern
- P – Previous vaccination history (crucial information)
- S – Symptoms timeline and exposure history
6. Nursing Management in Hospital Settings
Most cases of mumps can be managed at home, but hospitalization may be necessary for severe cases or when complications develop. Nursing management in the hospital setting focuses on comprehensive assessment, symptom management, and prevention of disease spread.
6.1 Nursing Assessment
| Assessment Component | Key Elements | Nursing Considerations |
|---|---|---|
| Health History |
|
Document MMR vaccination history; identify potential contacts; establish symptom progression timeline |
| Physical Assessment |
|
Monitor fever pattern; document size and tenderness of parotid swelling; assess for signs of dehydration; perform focused assessments based on presenting symptoms |
| Pain Assessment |
|
Use age-appropriate pain assessment tools; document pain in relation to activities like eating, talking, or movement |
| Nutritional Assessment |
|
Monitor food and fluid intake; assess for difficulties with mastication or swallowing due to pain |
| Complication Monitoring |
|
Perform regular assessments for early detection of complications; report significant changes promptly |
6.2 Nursing Interventions
Pain and Discomfort Management
- Administer analgesics as prescribed (acetaminophen or ibuprofen)
- Apply warm or cold compresses to the parotid area as tolerated
- Position patient with head elevated to reduce pressure on parotid glands
- Provide soft, bland diet that requires minimal chewing
- Avoid acidic foods and beverages that may stimulate salivary flow and increase pain
Fever Management
- Monitor temperature every 4 hours or as indicated
- Administer antipyretics as prescribed
- Provide cooling measures if fever exceeds 39°C
- Ensure adequate hydration
- Monitor for response to antipyretics
- Document fever pattern to identify trends
Hydration and Nutrition
- Encourage fluid intake to prevent dehydration
- Offer cool, non-acidic beverages
- Provide small, frequent meals of soft foods
- Monitor intake and output
- Observe for signs of dehydration
- Initiate IV fluid therapy if oral intake is inadequate
Isolation and Infection Control
- Implement droplet precautions for 5 days from onset of parotid swelling
- Ensure proper hand hygiene
- Limit patient movement outside room
- Educate visitors about precautions
- Provide mask for patient if transport is necessary
- Cohort patients with confirmed mumps if possible
Management of Specific Complications
Orchitis:
- Provide scrotal support (folded towel or athletic supporter)
- Apply cold compresses to reduce swelling and pain
- Administer analgesics as prescribed
- Monitor for signs of testicular torsion requiring immediate surgical intervention
- Educate about fertility concerns (usually preserved even with bilateral orchitis)
Aseptic Meningitis:
- Maintain neurological assessment q2-4h
- Promote restful environment with reduced noise and light
- Position with head slightly elevated
- Administer analgesics for headache
- Monitor for signs of increased intracranial pressure
6.3 Medication Management
Mumps is a viral infection, and treatment is primarily supportive. There are no specific antiviral medications for mumps, but the following medications may be used for symptom management:
| Medication | Purpose | Nursing Considerations |
|---|---|---|
| Acetaminophen (Paracetamol) | Relief of pain and fever |
|
| Ibuprofen | Relief of pain, fever, and inflammation |
|
| IV Fluids (if needed) | Correction of dehydration |
|
| Antiemetics (if needed) | Control of nausea and vomiting |
|
Mnemonic: “PAROTID” for Nursing Interventions in Mumps
- P – Pain management (analgesics, compresses)
- A – Adequate hydration and nutrition
- R – Rest and comfort measures
- O – Observe for complications
- T – Temperature monitoring and management
- I – Isolation precautions
- D – Documentation and education
7. Nursing Management in Home Settings
Most children with mumps can be managed at home with appropriate guidance from healthcare providers. Nursing management in home settings focuses on educating caregivers about symptom management, home care techniques, and preventing disease transmission.
7.1 Home Care Instructions
Comfort Measures
- Apply warm or cold compresses to the swollen parotid glands (whichever provides more relief)
- Administer pain relievers as prescribed (acetaminophen or ibuprofen)
- Encourage rest with head slightly elevated
- Provide soft, bland foods that require minimal chewing
- Avoid acidic foods and beverages that stimulate salivary flow
- Encourage gentle mouth care with warm salt water rinses
Hydration and Nutrition
- Offer small, frequent sips of clear fluids
- Provide soft, easily swallowed foods (yogurt, mashed potatoes, smoothies, soups)
- Avoid hot, spicy, sour, or crunchy foods
- Monitor urine output and color as indicators of hydration status
- Use straws if drinking is painful
- Maintain food diary to ensure adequate nutrition
Fever Management
- Monitor temperature regularly (at least 2-3 times daily)
- Administer antipyretics as prescribed
- Encourage light clothing and comfortable room temperature
- Provide extra fluids during febrile periods
- Use tepid sponging if fever exceeds 39°C despite medication
- Document fever pattern and response to interventions
Activity Management
- Encourage rest during the acute phase
- Provide quiet activities (reading, drawing, watching television)
- Gradually increase activity as symptoms improve
- Avoid contact sports or strenuous activities until fully recovered
- Plan for absence from school/daycare (5 days from onset of parotid swelling)
- Balance rest periods with gentle activity to prevent deconditioning
Home Care for Specific Complications
Orchitis Care at Home:
- Scrotal support with athletic supporter or folded towel
- Ice packs (wrapped in cloth) applied for 20 minutes every 2-3 hours
- Bed rest during acute phase with scrotum elevated
- Pain management with prescribed medications
- Monitor for worsening symptoms requiring medical attention
Signs Requiring Medical Attention:
- Persistent high fever (>39.5°C) despite antipyretics
- Severe headache, neck stiffness, or photophobia
- Persistent vomiting or inability to maintain hydration
- Severe abdominal pain
- Testicular pain that is severe or increasing
- Changes in mental status or behavior
- Development of hearing problems
7.2 Caregiver Education
Effective caregiver education is essential for successful home management of mumps. Key educational components include:
| Education Topic | Key Points to Cover | Teaching Strategies |
|---|---|---|
| Disease Information |
|
|
| Medication Administration |
|
|
| Infection Control |
|
|
| Complication Recognition |
|
|
7.3 Follow-up Care
Appropriate follow-up care ensures recovery is proceeding as expected and allows for early identification of potential complications:
Follow-up Schedule
- Telephone follow-up within 24-48 hours after diagnosis
- Office visit 7-10 days after diagnosis if complications present
- Additional visits as indicated by specific complications
- Hearing assessment 3-6 months after recovery if meningitis occurred
- Return to healthcare provider if symptoms worsen or new symptoms develop
Recovery Monitoring
- Resolution of parotid swelling (typically 7-10 days)
- Return to normal eating patterns
- Resolution of fever
- Return of energy levels
- Weight maintenance or return to pre-illness weight
- Resolution of any complications
Home Care Diary
Provide caregivers with a diary template to track the following information:
- Daily temperature readings
- Medication administration (time, dose, response)
- Fluid intake and output (if feasible)
- Food intake
- Changes in symptoms
- Any new symptoms
- Questions for healthcare provider
This diary helps with continuity of care and serves as a valuable record during follow-up visits.
8. Prevention and Control Measures
Preventing mumps transmission and controlling outbreaks are critical public health functions. Nurses play a vital role in patient education, vaccination promotion, and implementing infection control measures.
8.1 Immunization
MMR Vaccination Schedule
First Dose
12-15 months of age
Provides ~78% immunity against mumps
Second Dose
4-6 years of age
Increases immunity to ~88%
Catch-up Vaccination
For unvaccinated individuals
At least 28 days between doses
Outbreak Response
Third dose may be recommended
Based on CDC/local health authority guidance
Vaccination Recommendations
- MMR (Measles, Mumps, Rubella) vaccine is the primary prevention method
- Two-dose schedule provides best protection:
- First dose at 12-15 months of age
- Second dose at 4-6 years of age
- Catch-up vaccination for unvaccinated children and adolescents
- Adults born in 1957 or later should have documentation of at least one dose of MMR
- During outbreaks, a third dose may be recommended for high-risk groups
Contraindications and Precautions
- Contraindications:
- Severe allergic reaction to a previous dose or vaccine component
- Pregnancy
- Severe immunodeficiency
- Precautions:
- Moderate or severe acute illness
- Recent blood product administration
- Thrombocytopenia or history of thrombocytopenic purpura
- Personal or family history of seizures
Nursing Role in Immunization
- Educate families about the importance of mumps vaccination
- Address vaccine hesitancy with evidence-based information
- Screen for contraindications and precautions before administration
- Ensure proper storage, handling, and administration of vaccines
- Document vaccinations accurately in medical records and immunization registries
- Monitor for adverse reactions after vaccination
- Promote completion of the full vaccination schedule
8.2 Isolation Precautions
Proper isolation precautions are essential to prevent the spread of mumps:
| Setting | Isolation Measures | Duration |
|---|---|---|
| Hospital |
|
Until 5 days after onset of parotid swelling |
| Home |
|
Until 5 days after onset of parotid swelling |
| School/Daycare |
|
Affected children: 5 days after onset of parotid swelling Unvaccinated contacts: may be excluded based on health department recommendations |
8.3 Outbreak Management
Mumps outbreaks require coordinated public health responses. Nurses often play key roles in outbreak identification, management, and response:
Outbreak Identification
- Recognize and report clusters of cases
- Assist with case definition and confirmation
- Help identify potential contacts
- Participate in active surveillance
- Collect specimens for laboratory confirmation
- Document case demographics and vaccination status
Outbreak Response
- Implement enhanced isolation precautions
- Conduct vaccination campaigns for susceptible individuals
- Consider third dose of MMR for high-risk groups
- Educate communities about mumps prevention
- Screen contacts for symptoms
- Collaborate with public health authorities
Mnemonic: “PREVENT MUMPS” for Prevention Strategies
- P – Promote vaccination for all eligible individuals
- R – Respiratory hygiene and cough etiquette
- E – Educate about transmission and symptoms
- V – Verify immunization status during healthcare visits
- E – Exclude infected individuals from school/work
- N – Notify contacts of potential exposure
- T – Track cases during outbreaks
- M – Maintain isolation for 5 days after parotid swelling
- U – Update immunization records
- M – Monitor exposed individuals for symptoms
- P – Practice proper hand hygiene
- S – Secure additional doses of vaccine for outbreaks
9. Mnemonics for Easy Learning
Mnemonics can aid in memorizing key aspects of mumps assessment, management, and prevention. Here are additional mnemonics specifically designed for nursing students:
“MUMPS” for Clinical Features
- M – Malaise and myalgia (prodromal symptoms)
- U – Unilateral or bilateral parotid swelling
- M – Mastication pain (pain with chewing)
- P – Pyrexia (fever)
- S – Salivary gland enlargement and tenderness
“ISOLATE” for Infection Control
- I – Implement droplet precautions
- S – Separate from susceptible individuals
- O – Observe for 5 days after parotid swelling
- L – Limit movement outside isolation area
- A – Avoid sharing personal items
- T – Teach hand hygiene and respiratory etiquette
- E – Ensure proper documentation and reporting
“COMFORT” for Symptom Management
- C – Cool/warm compresses for parotid area
- O – Oral hydration with non-acidic fluids
- M – Medications for pain and fever
- F – Food modifications (soft, bland diet)
- O – Optimal positioning (head elevated)
- R – Rest periods throughout the day
- T – Temperature monitoring regularly
“RED FLAGS” for Complications
- R – Resistant fever despite antipyretics
- E – Extreme headache with neck stiffness (meningitis)
- D – Decreased hearing or tinnitus
- F – Focal neurological signs (encephalitis)
- L – Labored breathing or chest pain
- A – Abdominal pain (pancreatitis)
- G – Genital pain in males (orchitis)
- S – Severe dehydration signs
“PAROTID SWELLING” Differential Diagnosis Mnemonic
- P – Paramyxovirus (mumps)
- A – Acute bacterial sialadenitis
- R – Recurrent parotitis of childhood
- O – Obstructive sialadenitis (stones)
- T – Tumor (benign or malignant)
- I – Infections (HIV, CMV, influenza)
- D – Drug-induced (phenylbutazone, iodides)
- S – Sjögren’s syndrome
- W – Wegener’s granulomatosis
- E – Eating disorders (malnutrition, bulimia)
- L – Lymphadenopathy (mimicking parotid swelling)
- L – Ludwig’s angina (submandibular involvement)
- I – Immunological disorders (sarcoidosis)
- N – Nutritional deficiencies
- G – Glandular hypoplasia/abnormalities
10. References
- Centers for Disease Control and Prevention. (2023). Mumps: For Healthcare Providers. Retrieved from https://www.cdc.gov/mumps/hcp.html
- World Health Organization. (2022). Mumps. Retrieved from https://www.who.int/news-room/fact-sheets/detail/mumps
- American Academy of Pediatrics. (2021). Red Book: 2021-2024 Report of the Committee on Infectious Diseases. Itasca, IL: American Academy of Pediatrics.
- Hviid, A., Rubin, S., & Mühlemann, K. (2008). Mumps. The Lancet, 371(9616), 932-944.
- Kutty, P. K., Kyaw, M. H., Dayan, G. H., Brady, M. T., Bocchini, J. A., Reef, S. E., … & Seward, J. F. (2010). Guidance for isolation precautions for mumps in the United States: a review of the scientific basis for policy change. Clinical Infectious Diseases, 50(12), 1619-1628.
- Heymann, D. L. (Ed.). (2022). Control of Communicable Diseases Manual (21st ed.). Washington, DC: American Public Health Association.
- Immunization Action Coalition. (2023). Mumps: Questions and Answers. Retrieved from https://www.immunize.org/catg.d/p4211.pdf
- Denny, F. W., & Glezen, W. P. (1997). Acute respiratory infections: mumps. In R. D. Feigin & J. D. Cherry (Eds.), Textbook of Pediatric Infectious Diseases (4th ed., pp. 2117-2129). Philadelphia, PA: W.B. Saunders.
- Su, S. B., Chang, H. L., & Chen, K. T. (2018). Current status of mumps virus infection: epidemiology, pathogenesis, and vaccine. International Journal of Environmental Research and Public Health, 15(8), 1618.
- Galazka, A. M., Robertson, S. E., & Kraigher, A. (1999). Mumps and mumps vaccine: a global review. Bulletin of the World Health Organization, 77(1), 3-14.