Glandular fever (infectious mononucleosis) in children and teenagers

NHS inform describes glandular fever as a viral infection that mostly affects young adults, normally gets better without treatment but can make you feel very ill. It is caused by the Epstein-Barr virus and is also known as infectious mononucleosis or mono.

The virus is found in saliva. NHS inform says it can be spread by kissing, coughs and sneezes, sharing cups, glasses and unwashed cutlery and sharing toothbrushes, and that the virus may stay in saliva for months after symptoms pass and, in some people, on and off for years.

The NHS lists a high temperature, swollen glands in the neck, head, armpits, elbows or groin, a sore throat, a rash (which may be harder to see on black or brown skin), headache and tiredness. NHS inform adds feeling generally unwell, aching muscles, chills, sweating, loss of appetite, swollen tonsils and adenoids that may affect breathing, a very red throat that oozes fluid, small red or purple spots on the roof of the mouth, puffiness around the eyes, a tender or swollen tummy and jaundice.

The tiredness is the feature families notice most. The NHS says it can be extreme, and that long-term tiredness may last several months in some people.

NHS inform says the GP will ask about symptoms, examine for swollen glands, tonsils, liver and spleen, and may recommend a blood test. The NHS says the blood test checks for the Epstein-Barr virus and helps rule out other illnesses such as tonsillitis. NHS inform notes that mumps has similar symptoms to glandular fever and tonsillitis, which is part of why a clinician's assessment helps.

The NHS says to rest, drink plenty of fluids, taking small sips frequently if swallowing is painful, and use paracetamol or ibuprofen, with no aspirin for children under 16. It says not to do strenuous activities like heavy lifting or playing sports. NHS inform notes that antibiotics or corticosteroids may occasionally be prescribed if complications develop, and that some people with severe symptoms need a few days in hospital.

Most people get better with no problems, says the NHS, but complications can include liver conditions such as hepatitis, inflammation of the heart, kidney problems, low platelets or sepsis, neurological conditions such as Guillain-Barre syndrome or Bell's palsy, a ruptured spleen and long-term tiredness. NHS inform says complications are uncommon but can be serious, and that a ruptured spleen may need surgery.

The link between glandular fever and the spleen is the reason for the advice on sport. A child recovering from glandular fever should follow the GP's advice on when to return to contact sport and heavy exertion, as the sources read do not give a specific time.

The NHS says to see a GP for a very high temperature or feeling hot, cold or shivery, a severe sore throat, swelling either side of the neck, extreme tiredness or a sore throat that is not getting better. It says to call NHS 111 for difficulty breathing or difficulty and pain when swallowing, and to call 999 if the person cannot swallow, including their own saliva, has severe difficulty breathing or has severe stomach pain. NHS inform adds rasping breathing (stridor) and intense stomach pain to its 999 list.

The NHS says glandular fever is spread through spit and that you are infectious for up to 7 weeks before symptoms and may be infectious for several months after being unwell. You can go back to school as soon as you feel better. UKHSA lists glandular fever as requiring no exclusion and no need to contact the health protection team. Practical steps from the NHS are regular handwashing, washing anything that may have spit on it, not kissing others, not sharing cups or cutlery and not giving blood.