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Published originally in ParentMap Magazine.
Your Teen's Case of Mono
By Sally James
When her son called from his California college dorm room, Bellevue mother Karen Walters could tell he was sick. While his symptoms weren't severe — he complained of tiredness and had a slight fever — her mother radar bleeped a warning. She urged him onto a plane for a weekend at home.
Once in Seattle, he was soon flat on his back with a fever of 104 and a diagnosis of mononucleosis. His case was more severe than most, but mono is a common disease in young people. Understanding the symptoms and the rest needed to recover is essential for parents.
Mono is usually caused by the Epstein-Barr virus. The virus is very common; more than 80 percent of U.S. adults carry evidence that they once were infected. For younger children, EBV infection may cause only mild symptoms and pass unnoticed. For teens and young adults, however, an EBV infection often causes swollen lymph glands in the neck, a sore throat, a fever, and extreme fatigue. Recovery can take four to eight weeks. Sometimes fatigue lasts even longer.
The only treatment for mono is rest, says Dr. Cora Collette Breuner, director of the adolescent medical clinic at Children's Hospital and Medical Center in Seattle and an assistant professor at the University of Washington Medical Center. Breuner knows that making teenagers slow down is a challenge.
"I usually get very concrete with them," Breuner explains. "I tell them to make an Excel spread sheet with everything they do on it, and they need to put bedtime on their schedule. Dinner is not standing in the garage eating with your cleats on."
Mono is usually diagnosed by a characteristic trio of symptoms, but there is also a blood test that can indicate a viral infection. Once a diagnosis is confirmed, rest and rest and more rest is prescribed. The viral infection can cause the spleen to be enlarged, and so contact sports should be avoided for four to six weeks. (The spleen is a gland on the upper left side of the abdomen. In rare cases, a blow to an inflamed spleen will cause it to rupture and require emergency surgery.)
Breuner urges coaches, school nurses and parents to reinforce the rest requirement. If a parent's warnings are not effective, she recommends asking a friend's mother to make the case to your child.
When Nancy Johnston's daughter, Molly, got mono as a sophomore in a Bellevue high school, she was playing on both basketball and water polo teams. It was June. She missed four final exams, her brother's graduation, her mother's 50th birthday and a Father's Day barbecue. But her coaches were great, Johnston remembers.
"Her basketball coach let her come watch practice, but she was not allowed to run," Johnston recalls.
A teen with mono should stay home and rest for the first few weeks, but quarantine is not necessary. The disease is spread through the exchange of saliva or other fluids. Sharing water bottles at soccer games, for example. It's not airborne like flu viruses. A teen with mono should avoid public places where people may have weakened immune systems, such as clinics or hospitals.
Nursing a teen can require a different strategy than nursing a younger child. Teens, at a stage of life when they are striving more independence, may be less likely to follow directions. Because of their sore throats, getting them to take enough fluids to avoid dehydration is a big problem. Karen Walters faced off with her son, Wilson, like a gunslinger at the OK Corral.
"I'm five feet tall and he's over six feet. I brought him a container of Gatorade, and I set it in front of him and I told him it wasn't a choice. I told him he had better finish it before I came back upstairs."
Wilson recovered. As ParentMap was going to press, Walters had just found out that her daughter, a college freshman this year, might have mono.