By Drs. Sally Robinson and Keith Bly

You’ve probably heard of “mono” or mononucleosis. It is an infection that produces flu-like symptoms and usually goes away on its own in a few weeks. The Epstein-Barr virus, a common virus that most children encounter at some point, usually causes mono. Other organisms, including cytomegalovirus, adenovirus, HIV, toxoplasma, rubella and hepatitis, can occasionally cause mono.

Infants and young children infected with Epstein-Barr virus, or EBV, usually have mild symptoms, if any. Older children, teens and young adults, exposed to EBV often develop mono. Mono is spread through kissing, coughing, sneezing or any contact with saliva, including sharing utensils with someone infected with the virus.

Symptoms of mono include fever, sore throat, swollen lymph nodes, unexplained fatigue or weakness, headache, sore muscles, enlarged liver and spleen, skin rash and abdominal pain; the infection may be mistaken for the flu. Some children may have combinations of these symptoms, while others may have symptoms so mild that they aren’t noticeable.

Whatever the intensity of the symptoms, most of them usually go away on their own in two to four weeks. The enlarged lymph nodes and spleen may last longer. In some children, especially teens, the fatigue and weakness may last for months.

The only way to prevent your child from contracting the Epstein-Barr virus is to make sure that he avoids close contact with other children who have it. Your child’s doctor may test his blood to diagnosis the disease. The test may be negative for children under age 4, or in the first week of symptoms for a child of any age. The best treatment for mono is rest, plenty of fluids and a fever or pain reliever, such as acetaminophen or ibuprofen. Avoid giving your child aspirin, especially if he has a fever.

Most children recover completely with no problems, but in some rare cases complications may occur. These include hemolytic anemia, a condition in which blood cells deteriorate prematurely; Bell’s palsy, which is an inflammation of a facial nerve that temporarily weakens and paralyzes facial muscles; rupture of the spleen; and myocarditis, which is inflammation of the heart muscle.

EBV can stay alive in salvia for six months or more after a child recovers from mono, but EBV will remain in her body for the rest of her life and will reappear in the saliva periodically.

Consult your pediatrician if your child develops abdominal pain, if his fever doesn’t go away within a few days, or if he isn’t able to drink plenty of fluids. Your pediatrician should monitor your child closely until he is completely recovered and able to resume his usual activities.

Dr. Sally Robinson is a pediatrician in the division of children’s special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB.
The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email

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