Red flags & when to go in person for Mononucleosis (Suspected) - Triage

Audience: pediatric

Mononucleosis, often called "mono" or the "kissing disease," is a common viral infection in children and teens. It usually causes symptoms like sore throat, fever, swollen glands, and tiredness. Most children recover well with rest and fluids. However, some signs mean your child needs to see a healthcare provider in person quickly. These include trouble breathing, severe belly pain, very high fever, or unusual weakness. Telemedicine can help by offering advice, checking symptoms, and guiding you on care steps at home. But it cannot perform physical exams or urgent tests needed for serious problems. This guide helps you understand when to use telemedicine and when to seek in-person care for suspected mononucleosis in children. Always watch for red flags and trust your instincts about your child’s health.

Red flags — go in person / ER

• Difficulty breathing or swallowing — seek emergency care immediately.
• Severe abdominal pain or swelling — go to an emergency department.
• Very high fever not responding to fever reducers — see a healthcare provider in person promptly.

What telemedicine can do

• Assessing mild symptoms like sore throat, mild fever, and fatigue.
• Providing advice on home care and symptom monitoring.
• Guiding when to seek in-person care.

What telemedicine cannot do

• Performing physical examinations or throat swabs.
• Ordering or interpreting blood tests and imaging.
• Managing severe symptoms or emergencies.

What is Mononucleosis?

Mononucleosis is a viral infection caused by the Epstein-Barr virus. It spreads through saliva, so it’s sometimes called the "kissing disease." It most often affects children and teenagers. Common symptoms include sore throat, fever, swollen lymph nodes (glands), and feeling very tired. Most kids get better with rest and fluids over a few weeks.

When to Use Telemedicine for Suspected Mono

Telemedicine is useful if your child has mild symptoms like a sore throat, mild fever, or fatigue. A healthcare provider can ask about symptoms, give advice on home care, and help you decide if your child needs to be seen in person. Telemedicine can also help monitor symptoms over time.

Red Flags: When to Go In Person or Seek Emergency Care

Some signs mean your child needs urgent in-person care:

If you notice any of these, seek emergency care immediately.

What Telemedicine Cannot Do

Telemedicine cannot perform a physical exam, throat swab, blood tests, or imaging studies. These may be needed to confirm mononucleosis or rule out other serious conditions. If your child’s symptoms worsen or do not improve, an in-person visit is important.

Preparing for a Telemedicine Visit

Before the visit, gather information such as:

Make sure you have a quiet place with good internet or phone connection.

After the Telemedicine Visit

Follow the healthcare provider’s advice carefully. This may include:

Keep emergency numbers handy in case your child’s condition changes quickly.

How to prepare for your tele-visit

• Note the start and progression of your child's symptoms.
• List any medications your child has taken, including doses.
• Prepare to describe any allergies or existing health conditions.
• Have a list of questions or concerns ready.
• Ensure a quiet, well-lit space with a reliable internet or phone connection.

After your tele-visit

• Follow the healthcare provider’s instructions on medication and care.
• Encourage your child to rest and drink plenty of fluids.
• Monitor symptoms closely for any worsening or new signs.
• Schedule an in-person visit if advised or if symptoms do not improve.
• Seek emergency care if red flag symptoms develop.

FAQs

What causes mononucleosis in children?

Mononucleosis is usually caused by the Epstein-Barr virus, which spreads through saliva. It can be passed by sharing drinks, utensils, or close contact like kissing.

How long does it take for a child to recover from mono?

Recovery often takes 2 to 4 weeks, but some children may feel tired for several more weeks. Rest and good nutrition help recovery.

Can antibiotics treat mononucleosis?

No, antibiotics do not work against viruses like the Epstein-Barr virus. They are only used if there is a bacterial infection alongside mono.

When should I be worried about my child’s sore throat?

If your child has difficulty breathing, swallowing, very high fever, or severe pain, seek medical care right away. These may be signs of complications.

Is mononucleosis contagious?

Yes, mono spreads through saliva and close contact. It’s best to avoid sharing drinks or utensils and to practice good hygiene.

Sources

1. Mononucleosis — MedlinePlus, U.S. National Library of Medicine.
2. Infectious Mononucleosis — Centers for Disease Control and Prevention (CDC).
3. Mononucleosis (Mono) — Mayo Clinic.
4. Mononucleosis — Merck Manuals Consumer Version.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child has severe symptoms or you are concerned about their health, seek immediate medical attention.