Springdale Mason Pediatrics

Mono (Infectious Mononucleosis)


  • Mononucleosis (mono) is a viral infection of the lymph nodes
  • Main symptoms are sore throat and widespread swollen lymph nodes

Call or Return If

  • Trouble breathing or drooling occurs
  • Your child can't drink enough fluids
  • Fever lasts more than 7 days
  • Stomach pain occurs (especially sharp pain high on the left side)
  • Your child isn't back to school by 2 weeks.
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic


  • Severe sore throat
  • Large red tonsils covered with pus
  • Swollen lymph nodes in the neck, armpits, and groin
  • Fever for up to 7 days
  • Tiredness and increased sleeping
  • Enlarged spleen (in 50% of children)


  • Mono is diagnosed by positive blood tests
  • Blood smear shows many atypical (unusual) white blood cells


  • Mono is caused by the Epstein-Barr virus (EBV).
  • This virus is passed to others in infected saliva (spit).
  • Occurs more often in 15- to 25-year-olds. Reason: more intimate contacts with others.
  • After the virus enters the body, it can take 4 to 7 weeks before symptoms begin.

Chronic Fatigue Syndrome

  • The symptoms of chronic fatigue syndrome are tiredness and weakness. There is also a constant feeling that you need more sleep.
  • The symptoms must be present for at least 6 months.
  • Any connection to mono has never been proven.

Prevention of Spread to Others

  • Mono is not very contagious. People in the same household rarely come down with it.
  • Avoid kissing at least until the fever and sore throat are gone.
  • Also use separate drinking glasses and utensils for the same time.

After Care Advice

  • Mono is a viral infection of the lymph nodes.
  • Symptoms will go away on their own. This is usually within a week to 10 days.
  • There is no drug that can cure mono.
  • Here is some care advice that should help.
Sore Throat Pain Relief:
  • Age over 1 year. Can sip warm fluids such as chicken broth or apple juice.
  • Age over 6 years. Can also suck on hard candy or lollipops. Butterscotch seems to help.
  • Age over 8 years. Can also gargle. Use warm water with a little table salt added. A liquid antacid can be added instead of salt. Use Mylanta or the store brand. No prescription is needed.
  • Medicated throat sprays or lozenges are generally not helpful.
Pain Medicine:
  • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
  • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. Note: Lower fevers are important for fighting infections.
  • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
Antibiotics Not Needed:
  • Only bacterial infections are helped by antibiotics.
  • Antibiotics will not kill viruses.
Fluids and Soft Diet:
  • Try to get your child to drink adequate fluids. Goal: Keep your child well hydrated.
  • Cold drinks, milk shakes, popsicles, slushes, and sherbet are good choices.
  • Solids. Offer a soft diet. Also avoid foods that need much chewing. Avoid citrus, salty, or spicy foods. Note: Fluid intake is much more important than eating any solids.
  • Swollen tonsils can make some solid foods hard to swallow.
  • Bed rest will not shorten the course of the illness or reduce symptoms.
  • Your child can select how much rest he or she needs.
Activity and Precautions for an Enlarged Spleen:
  • The spleen gets bigger than normal in 50% of those with mono.
  • A blow to the belly area could rupture the enlarged spleen. This can cause serious bleeding and is a surgical emergency.
  • All children with mono need to avoid contact sports and exercise. Avoid these activities for at least 4 weeks.
  • Your doctor will check your child's spleen size by exam. You should get the medical okay to return to sports from your doctor.
What to Expect:
  • Most children have only mild symptoms that last about a week.
  • Even those with severe symptoms usually feel completely well in 2 to 4 weeks.
  • The most common complication is dehydration from not drinking enough fluids.
Return to School:
  • Children can return to school when the fever is gone. They should also be able to swallow normally.
  • Most children will want to be back to full activity in 2 to 4 weeks.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2021 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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