Glandular Fever in Teens: Signs Parents Must Know

When Sam was recently sent home from school feeling badly fatigued, and with suspected mental health problems, I had a worried mum on the phone asking me what to do. Here’s what happened, and what we did.

She told me that the school were putting him under far too much pressure and not feeding him properly. The school said he was anxious and needed counselling. So I asked her for a bit more background and what Sam had been up to in the weeks and months beforehand. When she got to the bit about him having kissed 20 people at a teenage party in the school holidays, I immediately suspected glandular fever.

I suggested some blood tests which could give us a better clue. Sure enough, the results came back showing an active virus called Epstein-Barr, which is the one that triggers glandular fever. It is also known as the kissing disease or infectious mononucleosis (‘mono’).

If your child went to a party, a festival or even just a social event a few weeks ago and is now dragging themselves through the school term, this one is worth reading to the end. It could save you weeks of worry.

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How glandular fever spreads

The Epstein-Barr virus is usually transmitted through saliva, and it can affect young children and adults just as much as teens and young adults. Your adolescent doesn’t even have to kiss to catch it, as spit can be carried on hands too, and sharing drinks is another common way to pass it around. It can take up to four to six weeks for symptoms to develop (roll back a month to those Christmas or summer teen snogathons), and your child can also infect others during this time.

Signs your child might have glandular fever

Here are some things to watch out for that could point to glandular fever:

An ongoing sore throat that doesn’t seem to shift.
Swollen glands on either side of the neck.
Tonsillitis that persists.
Fever that comes and goes.
Feeling hot and shivery.
Headaches that feel different from their usual ones.
Deep exhaustion that a full night’s sleep doesn’t seem to fix.
Low mood or emotional flatness that seems out of character.

One lesser-known sign to watch out for is a puffy, swollen upper eyelid, sometimes giving your teenager a distinctly “sleepy face” appearance. This is called the Hoagland sign, first described back in 1952, and it is surprisingly common in glandular fever. A prospective study found it in around a third of confirmed cases, suggesting it may be more common than an enlarged liver or spleen. It tends to appear early in the illness, it is painless and it usually resolves within a couple of weeks.

What makes the Hoagland sign clinically useful is that it can show up before the more classic symptoms of glandular fever kick in, so if your teenager comes home from a party or festival looking unusually puffy around the eyes and then develops a sore throat and fatigue a few days later, it could be an early clue. It is often mistaken for an allergic reaction, so it is worth mentioning to your GP if you spot it alongside other symptoms.

Low mood and EBV

One thing that catches many parents off guard is how much glandular fever can affect a teenager’s mental health. As well as the frustrations of missing out on school and their social life, research finds that the Epstein-Barr virus can directly influence a teen’s mood and emotional wellbeing. A large Danish nationwide study following over 1.4 million young people found that catching this virus during adolescence was associated with a much increased risk of developing depression during early adulthood.

So if your teenager seems emotionally flat, tearful, anxious or withdrawn beyond what you would expect, take it seriously. This is not them being dramatic, and it could be the virus talking. Keep the lines of communication open with them, validate how they are feeling, and if their low mood persists beyond the acute illness, consider additional nutritional and psychological support.

What to do straight away

Rest and sleep are the most important things to do right now. Glandular fever is absolutely exhausting, and the body needs time to recover. Whether it is being asleep in bed or curled up in a duvet on a sofa, rest is absolutely vital.

Make sure your teenager stays well hydrated. Ideally, they should drink plenty of filtered water, as well as hot honey, fresh ginger and lemon. Also, encourage freshly made juices packed with fruit, veg, ginger and citrus.

It is important for them to avoid alcohol entirely, as the liver can be weakened during this infection. This is because liver enzymes are usually raised in blood tests when suffering from Epstein-Barr, and any additional alcohol will be a further burden on the liver.

It is also worth checking your child’s iron levels, as the virus can lead to anaemia or iron deficiency, which reduces oxygen-carrying capacity in red blood cells and can further magnify fatigue and lengthen recovery time. Their blood tests may show a picture of low ferritin (iron stores) under 30 ug/L or a low haemoglobin level, indicating they need more iron, folate and vitamin B12.

Sometimes the ferritin marker in the blood tests is the opposite and very high, while the other iron markers are low. This can indicate an acute short-term condition called hyperferritinemia, which suggests that the Epstein-Barr virus has driven more widespread inflammation throughout the body, and that a cytokine storm will require more medical and nutritional support, as it is a more serious case.

The spleen can also swell, so it is important to avoid high-impact or intensive sports with a high risk of body contact, such as rugby, football, or hockey, as well as to avoid lifting heavy weights for 3-4 weeks. They should only be allowed back to sport if the spleen has normalised and is given the go-ahead by their GP.

It is ok to do gentle exercise, such as walking and stretching, and as your teen starts to feel better by about week 3, gradually build up their physical activity day by day.

One thing I’d encourage is for them to talk and not feel alone. Get them chatting to their friends, because chances are they might have glandular fever too, and they can support each other through this. We know of some very active WhatsApp groups where the teens have given the virus to each other a few weeks beforehand, and they are all recuperating at their respective homes together.

While getting better, your teenager should take care not to spread it further to friends or other family members. This means not kissing anyone during this time. Also, it is important to regularly wash their hands, clothes, bedding and towels, and not to share anything that might carry the virus, such as cutlery, glasses, cups, napkins or towels.

Sleep quality matters

Rest is absolutely essential during glandular fever recovery, but it is worth paying attention to the quality of your teenager’s sleep, not just how many hours they are clocking up. Research into post-viral fatigue has found that EBV commonly causes a distinct pattern of needing excessive sleep, alongside unrefreshing rest. This means your teenager can sleep for ten or twelve hours and still wake up feeling completely drained.

EBV-related fatigue has also been linked to excessive daytime sleepiness, followed by the frustration of finding it hard to get to sleep, knocking out their natural circadian rhythm. This is why good sleep hygiene really matters during recovery from glandular fever. Encourage a consistent bedtime, keep screens out of the bedroom in the hour before sleep, make the room cool and dark, and discourage excessively long daytime naps after the first week or two, as these can disrupt overnight sleep. Consider sleepy supplements containing magnesium, cherry, lemon balm and glycine if they are finding it hard to get to sleep.

Extra nutrition and supplement support

This is where the right nutrition can really make a difference. The body needs good nourishment to fight off this pesky virus and recover properly, and this is a brilliant opportunity to pack in the good stuff.

Supercharge their plate

Fill their plates with fruits, vegetables, soups and stews as well as meat, fish, eggs and beans. Spice up their food with garlic and ginger, as these have natural immune-supporting properties. Try Jarrah or Manuka active honeys to soothe the throat with their antimicrobial activity, and they can also give a little natural energy boost.

Herbal home remedies

There are also some specific nutrients and herbal supplements worth considering. Natural antivirals like Elderberry, Olive Leaf extract, Thyme and Oregano are traditionally used and show promise in laboratory research. These can be really helpful whilst the virus is still active, especially if there are lingering upper respiratory symptoms such as swollen glands.

Key nutrients

B vitamins, iron, and Vitamin D should also be optimised, as Epstein-Barr Virus can sometimes come alongside anaemia, depleted iron stores and other nutrient deficiencies. The nutrients are vital for rebuilding energy reserves and supporting the immune system when it has had a bashing.

Lactoferrin, that immune molecule found in breast milk and in cow’s milk, is known to help with iron transport. It also reduces viral replication and may support overall immune and energy when dealing with glandular fever and during recuperation. This can now be found in supplement form, and we find that taking it daily for at least 6 weeks can be very helpful.

Getting enough zinc is also critical. This is the mineral most needed by both boys and girls during puberty, so teens are at particularly high risk of being deficient. Zinc is found in pumpkin seeds, nuts, fish, meat, eggs and dairy and in particular shellfish. Many teens benefit from taking a zinc supplement during the active phase of Epstein-Barr and until they are fully recuperated and back to their old selves.

Work on inflammation and oxidative stress

You can also work on reducing systemic inflammation and oxidative stress by including plenty of vitamin C-rich foods (plus a high-strength vitamin C supplement), such as oranges, lemons, limes, pineapple, kiwi, strawberries, parsley and red peppers. Berries, turmeric, and omega-3 from oily fish or fish oil supplements all have anti-inflammatory properties (but avoid turmeric if the liver enzymes are raised).

Food supplements with antioxidant properties, such as quercetin, resveratrol, broccoli extract, and green tea, are also worth considering to help quell the oxidative stress (cell damage) from the virus.

How long does recovery take?

Your teenager could well be back at school, at least part-time, within two to three weeks. But some teens take much longer to feel 100% better and need a longer recuperation period. The reality is more like a six-week recovery for most kids, and some can feel really tired and run down for several months afterwards and go on to develop post-viral fatigue.

Working with your child’s school

Missing weeks of school is stressful for any teenager, especially if GCSEs, A-levels or other exams are looming. This means the sooner you get the school on side, the better. I suggest you contact your child’s head of year or form tutor early on, and ask your child’s GP to provide a medical letter confirming the glandular fever diagnosis and expected recovery timeline.

Most schools will support a phased return, which might perhaps look like mornings only at first, or only attending lessons for their core subjects while resting at home for the rest of the day. Some may find remote learning easier. If your child is in an exam year, it is worth asking the school’s exams officer about special consideration or access arrangements, as medical evidence of glandular fever during the exam period can qualify for these.

Some teenagers try to push through and go back too early, which often leads to a relapse and even more time off. A gradual, planned return with rest days built in is almost always more effective than a brave face, followed by a crash two weeks later. Your teenager’s health comes first, and their schoolwork can be caught up later.

The longer-term picture

Most teens recover quickly from glandular fever, don’t ever look back and only have the stress of catching up on their missed schoolwork and their social life.

Like other viruses, the Epstein-Barr Virus remains inactive within your body for the rest of your life, which is called latency. However, in some cases, the virus can reactivate later in life, causing episodes of fatigue and illness. It can be re-triggered by periods of stress or when feeling depleted.

In the last decade, research has also found that Epstein-Barr has the potential to play a role in a whole host of autoimmune diseases. It is linked to the onset of lupus, multiple sclerosis, rheumatoid arthritis, juvenile idiopathic arthritis, inflammatory bowel disease, Hashimoto’s thyroiditis, coeliac disease and type 1 diabetes.

It is generally thought that to develop a post-viral autoimmune disease, you need to have both a genetic predisposition and it may also involve intestinal permeability. So if you know you have known autoimmunity in the family and your child has had some low-grade niggly gut issues, allergies, eczema, asthma or has needed to take antibiotics recently, then this is when the Epstein-Barr Virus might get the autoimmune ball rolling. If this is your family or your child, then it is really worth going above and beyond to work on their recovery and recuperation while they are still at home. And during recuperation aim to feed and nourish them with their future health in mind.

As ever, do consult your doctor, especially if symptoms worsen, as complications can arise. These can include anaemia, secondary infections or neurological illnesses like Guillain-Barré syndrome.

Round up

Glandular fever can be a worrying time for any parent, but the good news is that most teenagers bounce back well with the right support. Focus on rest, nourishment and targeted nutritional support, and keep a close eye on how they are feeling week by week.

If your teenager is struggling to recover, or if you are concerned about the longer-term effects of Epstein-Barr Virus, our NatureDoc clinical team can carry out a more thorough check of their immune system, gut health, adrenal response, thyroid, inflammatory pathways and underlying nutritional reserves. From there, we can put together a more targeted plan to get their body stronger. Book a consultation with us, and we’ll take it from there.

If you found this helpful, please do share it with friends and family who might be going through the same thing. The more parents who know what to look for, the better.

In this post, names have been changed for confidentiality, and of course to save blushes!

Ask me what supplements can help… or anything else!

NB. Updated from an original post 8 November 2020.

What to do when your darling teenager gets glandular fever from kissing 20 people at a party