Mumps is a generalized disease of the parotid glands, which are located in the cheeks and under each ear. The parotid is the largest in a group of glands that predominantly secrete saliva. When a child has the mumps, the parotid glands swell, which also is called parotitis.

The appearance of a child with mumps is sometimes described as making him or her “look like a chipmunk.” Sometimes the virus can affect other salivary glands and may result in swelling under the tongue or jaw. The disease is more common during late winter and early spring.

What Causes Mumps?

Mumps is caused by a virus. The mumps virus may enter the upper respiratory tract and begin to multiply. The virus is then spread by droplet spray or respiratory secretions from the infected person to other people or on any object such as a towel, washcloth, or eating utensils, which can then transmit the infectious agents.

The infectious period, which is the period in which an infected person can transmit mumps to another person, lasts from three days before symptoms appear to approximately nine days after the symptoms appear. The incubation time, which is the time required between acquiring the infection and the first symptoms of disease, averages from 16-18 days.

Typically, anyone with mumps should not attend childcare, school, work, or other public places for five days from the beginning of salivary gland swelling.

How Common is Mumps?

Prior to the licensing of a vaccine in 1967, mumps was very common. About 50 percent of children contracted the disease, and the U.S. averaged 200,000 cases each year. Since vaccinations began, the number of reported cases has dropped to fewer than 300 per year.

Children are routinely vaccinated against mumps with the MMR vaccine--Measles, Mumps, Rubella. If your program does not require vaccinations or you have children in your care who are unvaccinated because their parents have chosen to not immunize their children, then you may see a child with mumps in your program. If you have other unimmunized children or caregivers are under immunized, then a case of mumps in your setting can be of concern to others.

Before the mumps vaccine was introduced, most cases occurred in children between the ages of 5-9. In the 1980s, a reappearance of mumps occurred and generally affected children 10-19 years old.

It is believed that these cases occurred because of the lack of state immunization requirements. Most cases now occur in older children and adults.

Some people do not need to be concerned about catching the mumps. This group includes those who have had two doses of the vaccine after they were one year old, those who were born before 1957, or those who already have had the disease.

What are Symptoms of Mumps?

One of the first symptoms of mumps is a general sense of not feeling well, sometimes accompanied by a headache. A low-grade fever also may be present.

Within one or two days, the child may complain of tenderness in the area in front of and/or below the ears. The parotid gland will usually swell within two days. This is usually soon followed by complaints of pain in the swollen area when eating or drinking acidic foods, along with loss of appetite.

Mumps is usually diagnosed on the clinical presentation of not feeling well, fever, and swollen parotid glands. Blood tests can be done either to confirm the diagnosis of mumps or to determine if the glands are swollen for another reason.

Complications of Mumps

Several organs can be infected with the mumps virus. Orchitis, an inflammation of the testicles, is not common in young boys, but can occur in up to 50 percent of adolescent males.

In addition, involvement of the central nervous system (CNS) is common, but fewer than 10 percent of children have any central nervous system signs. If present, it usually resolves without complications in children.

Mumps also can cause hearing loss, which has been reported in one per 20,000 cases of mumps. Other complications, though rare, can occur.

How is Mumps Treated?

Treatment of mumps is usually supportive; that is, make sure the child is comfortable and well hydrated. The child’s physician may recommend a non-aspirin pain reliever for fever and muscle aches.

Do not give aspirin to a child or teenager who has a viral infection such as mumps. Aspirin has been associated with a serious condition known as Reye’s Syndrome, which is a potentially fatal disease that affects the liver and can cause swelling of the brain.

Since mumps is caused by a virus, antibiotics are useless against this germ. Antibiotics are indicated only if a parotitis is determined to be caused by a bacterial infection. Once the child recovers from mumps, it may be wise to get a hearing test to make sure that there was no damage to any of the hearing structures.

When Should the Doctor Be Contacted?

Most of the time, mumps is a benign disease; however, there are several “red flags” a parent or childcare provider should watch for:

• Persistent vomiting is present, which can lead to dehydration.
• The child is weak and listless (lethargic).
• He or she complains of neck stiffness or pain.
• The child suffers from abdominal pain.

If a child in your care is diagnosed with mumps, follow your program’s exclusion policies for having this child remain away for childcare. Notify parents of all enrolled children that their children may have been exposed, and inform them of disease symptoms. Mumps is a reportable disease in most states so report the case to the state health department.

The incidence of mumps is slowly increasing, partially because of some parents’ failure to have their children immunized. Mumps is generally a mild disease, but can cause unnecessary suffering and lost time from childcare, school, and work and may have serious complications in rare cases.

The best protection against mumps is immunization. Childcare providers should maintain accurate immunization records on all enrolled children and assure that every child has up-to-date immunizations.

Joe Knight
Family Practice Physician Assistant and Medical Writer, Fresno, CA

Internet Resources

Centers for Disease Control & Prevention,
www.cdc.gov/vaccines/vpd-vac/mumps/default.htm

Mumps Fact Sheet, www.familymanagement.com/childcare/facts/mumps.facts.html