Paeds · ent-hearing-and-oral-health

Salivary gland disorders

Also known as Mumps · Viral parotitis · Juvenile recurrent parotitis · Acute suppurative sialadenitis · Bacterial parotitis · Ranula · Plunging ranula · Sialolithiasis

Fellowship topic on salivary gland disorders in children. Covers mumps and its complications, juvenile recurrent parotitis and sialendoscopy, acute suppurative parotitis with anti-staphylococcal therapy, the simple and plunging ranula, sialolithiasis and neonatal parotitis. Builds the skill of distinguishing the common viral parotitis from the suppurative gland needing antibiotics and the recurrent or cystic lesion needing a different pathway, with ANZ, UK, US and Canadian guidance.

medium10 referencesUpdated 16 July 202614 min readVerification in progress

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RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

A febrile child with unilateral tender parotid swelling and purulent discharge from the Stensen duct — acute suppurative parotitis, usually Staphylococcus aureus; needs prompt anti-staphylococcal antibiotics and assessment for abscess, because untreated disease can progress to septicaemia in the neonate or immunocompromised child.A previously well child with bilateral parotid swelling, fever and malaise who develops headache, neck stiffness, photophobia or altered consciousness — mumps meningitis or encephalitis; cerebellar and cranial nerve involvement can accompany mumps, and sensorineural hearing loss, though rare, is permanent.A boy past puberty with mumps parotitis who develops acute testicular pain and swelling — mumps orchitis; it can cause testicular atrophy and, though infertility is uncommon, bilateral orchitis raises that risk.A child with a soft bluish swelling in the floor of the mouth that is growing or interfering with feeding and speech — a ranula; a plunging ranula may present as a cervical mass crossing the mylohyoid, and recurrent lesions need surgical assessment rather than observation alone.

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

community-schooloutpatiented-acutewardrural-remotetelehealth

Clinical exam formats

written-only

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General Paediatrics and ENT: salivary gland disorders — mumps and its complications, juvenile recurrent parotitis, acute suppurative parotitis, ranula and sialolithiasis, and the red flags that demand imaging, antibiotics or surgery.Infectious diseases and prevention: the viral and bacterial causes of paediatric salivary swelling, MMR vaccination for mumps prevention, and antimicrobial stewardship for self-limiting viral parotitis.Renewed curriculum — ENT and infectious diseases: sialendoscopy for refractory juvenile recurrent parotitis, the management of ranula and plunging ranula, and the complications of mumps including orchitis, meningitis and pancreatitis.Public health and regional practice: mumps resurgence in under-immunised communities, the burden of salivary disease in remote and migrant populations, and oral-health and immunisation promotion.General Paediatrics: recognition of mumps parotitis, the distinction between viral and suppurative parotitis, and the stepwise management of juvenile recurrent parotitis and ranula.Public health: MMR vaccination, isolation advice for mumps, and the safety-net for complications such as meningitis, orchitis and pancreatitis.Long Case / Structured discussion: a child with parotid swelling — classification, the focused examination of the gland and duct, the investigation of suppurative versus recurrent disease, and the stepwise management from supportive care to antibiotics or surgery.Communication station: explaining to a parent why most parotid swelling is viral and self-limiting, when antibiotics are needed, and why the MMR vaccine prevents mumps.Level 2 / 3 — ENT, infection and immunology: the causes of paediatric salivary gland swelling by age, the mumps and bacterial parotitis patterns, and the red flags of meningitis, orchitis and abscess.Public health and health improvement: MMR vaccination, isolation advice for mumps, and oral-health promotion.Foundation of Practice (FOP): the common and dangerous causes of salivary gland swelling in infants and children, and the bedside distinction between viral, bacterial and recurrent parotitis.Applied Knowledge in Practice (AKP): mumps complications, anti-staphylococcal therapy for suppurative parotitis, sialendoscopy for refractory juvenile recurrent parotitis, and the surgical management of ranula.History-taking and management: the child with parotid swelling and fever, the focused head and neck examination, and the supportive, antimicrobial or surgical plan.Communication: explaining why most parotid swelling is self-limiting, when to return for complications, and the role of MMR vaccination.General Pediatrics Content Outline: salivary gland disorders — mumps, juvenile recurrent parotitis, acute suppurative parotitis, ranula and sialolithiasis, with the complications of mumps.Infectious Diseases: mumps virus and vaccination, Staphylococcus aureus as the leading cause of suppurative parotitis, and neonatal parotitis.Patient Care: evidence-based, supportive-first management of paediatric salivary gland disease with prompt antibiotics for suppurative parotitis and recognition of complications.Systems-Based Practice and Population Health: MMR vaccination promotion, isolation advice, and antimicrobial stewardship for viral parotitis.Medical Knowledge: the viral, bacterial and structural pathophysiology of salivary gland disease, mumps complications, and the pharmacology of anti-staphylococcal agents.Medical Expert: salivary gland disorders diagnosis, supportive care of mumps, anti-staphylococcal therapy for suppurative parotitis, sialendoscopy for refractory juvenile recurrent parotitis, and ranula management.Health Advocate and Collaborator: MMR vaccination promotion, isolation advice, and oral-health and immunisation access in remote communities.Communicator: explaining why most parotid swelling is benign, when complications bring the child back, and the role of vaccination.

Your progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

community-schooloutpatiented-acutewardrural-remotetelehealth

Clinical exam formats

written-only

Board mappings

The fellowship answer

Salivary gland disorders in children span a spectrum from the common viral parotitis of mumps to the suppurative gland needing antibiotics and the recurrent or cystic lesion needing a surgical pathway. A child with bilateral tender parotid swelling, fever and malaise has mumps if under-immunised — supportive care, isolate for five days from swelling onset, and watch for orchitis, meningitis and pancreatitis. [1]

A child with recurrent episodes of unilateral or bilateral parotid swelling between flare-ups, starting before puberty, has juvenile recurrent parotitis — hydrate, massage the gland and use sialogogues; most resolve by puberty, but refractory disease may benefit from sialendoscopy. [3] [5]

A febrile child with unilateral, exquisitely tender parotid swelling and pus from the Stensen duct has acute suppurative parotitis — Staphylococcus aureus leads — and needs prompt anti-staphylococcal antibiotics and assessment for abscess. A ranula is a mucous retention cyst from the sublingual gland, presenting as a bluish floor-of-mouth swelling; plunging variants present in the neck and need surgical review. [2] [8]

The salivary-gland red flags

A febrile child with unilateral, tender parotid swelling and purulent Stensen duct discharge — acute suppurative parotitis, usually Staphylococcus aureus; start anti-staphylococcal antibiotics and look for abscess, because septicaemia can follow in the neonate or immunocompromised host. [9] [10]
Mumps parotitis with headache, neck stiffness, photophobia or altered consciousness — mumps meningitis or encephalitis; cerebellar signs and cranial nerve palsies can occur, and sensorineural hearing loss, though rare, is permanent. [1]
A post-pubertal boy with mumps who develops acute testicular pain and swelling — mumps orchitis; it can cause testicular atrophy and raises the infertility risk with bilateral involvement. [1]
A growing floor-of-mouth or cervical swelling in a child — a ranula or plunging ranula; recurrent or large lesions interfering with feeding, speech or the airway need surgical assessment, not observation alone. [7] [8]
A neonate with unilateral parotid swelling, fever and irritability — neonatal suppurative parotitis, a rare but serious infection often linked to prematurity and dehydration; it needs intravenous anti-staphylococcal therapy and a low threshold for drainage. [9] [10]

Overview & Definition

A four-year-old is sent home from childcare with bilateral cheek swelling and a low fever. The mother asks whether it is mumps and what to watch for. The fellowship skill is to read the swelling as viral or bacterial, recurrent or new, cystic or inflammatory — and to act on the few that carry danger. [1]

Salivary gland disorders in children cover any swelling, inflammation or cystic change of the parotid, submandibular, sublingual or minor salivary glands. The task is to separate the common self-limiting viral parotitis from the suppurative gland needing antibiotics, the recurrent pattern needing a work-up, and the cystic or structural lesion needing surgery. Most paediatric salivary swelling is viral and benign. A small minority — the suppurative parotitis of the neonate, mumps meningitis, recurrent parotitis that scars the gland — carry real harm. The examining skill is to read the gland, duct, host and the time course, because that quartet names the cause. [1] [2]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References10Show ledger

[1]Hviid A; Rubin S; Mühlemann K Mumps. Lancet, 2008.PMID 18342688
[2]Kim MJ; Milliren A Salivary Gland Disorders: Rapid Evidence Review. Am Fam Physician, 2024.PMID 38905553
[3]Wood J; Toll EC; Gregory S; Little C Juvenile recurrent parotitis: Review and proposed management algorithm. Int J Pediatr Otorhinolaryngol, 2021.PMID 33421670
[4]Garavello W; Redaelli M; Galli A Juvenile recurrent parotitis: A systematic review of treatment studies. Int J Pediatr Otorhinolaryngol, 2018.PMID 30055724
[5]Soriano-Martín D; García-Consuegra L; Peña-García P; et al Sialendoscopy approach in treating juvenile recurrent parotitis: a systematic review. J Otolaryngol Head Neck Surg, 2023.PMID 37598195
[6]Singh P; Gupta D Juvenile Recurrent Parotitis. Indian J Pediatr, 2019.PMID 30788670
[7]Nguyen K; Goodman E; Chhith S; et al Systematic Review and Meta-Analysis of the Management and Outcomes of Recurrent Ranulas. Oral Dis, 2026.PMID 41841403
[8]Bowers EMR; Schaitkin B Management of Mucoceles, Sialoceles, and Ranulas. Otolaryngol Clin North Am, 2021.PMID 34024482
[9]Mori T; Shimomura R; Himoto S; et al Neonatal suppurative parotitis: Case reports and literature review. Pediatr Int, 2022.PMID 33955624
[10]Pollenus J; Van Lierde S Neonatal Parotitis: A Case Report and Review of the Literature. Pediatr Infect Dis J, 2023.PMID 37171966

Salivary gland disorders

Also known as Mumps · Viral parotitis · Juvenile recurrent parotitis · Acute suppurative sialadenitis · Bacterial parotitis · Ranula · Plunging ranula · Sialolithiasis

medium10 referencesUpdated 16 July 202614 min readVerification in progress

Practise this topic

Overview & Definition

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References10Show ledger

[1]Hviid A; Rubin S; Mühlemann K Mumps. Lancet, 2008.PMID 18342688
[2]Kim MJ; Milliren A Salivary Gland Disorders: Rapid Evidence Review. Am Fam Physician, 2024.PMID 38905553
[3]Wood J; Toll EC; Gregory S; Little C Juvenile recurrent parotitis: Review and proposed management algorithm. Int J Pediatr Otorhinolaryngol, 2021.PMID 33421670
[4]Garavello W; Redaelli M; Galli A Juvenile recurrent parotitis: A systematic review of treatment studies. Int J Pediatr Otorhinolaryngol, 2018.PMID 30055724
[5]Soriano-Martín D; García-Consuegra L; Peña-García P; et al Sialendoscopy approach in treating juvenile recurrent parotitis: a systematic review. J Otolaryngol Head Neck Surg, 2023.PMID 37598195
[6]Singh P; Gupta D Juvenile Recurrent Parotitis. Indian J Pediatr, 2019.PMID 30788670
[7]Nguyen K; Goodman E; Chhith S; et al Systematic Review and Meta-Analysis of the Management and Outcomes of Recurrent Ranulas. Oral Dis, 2026.PMID 41841403
[8]Bowers EMR; Schaitkin B Management of Mucoceles, Sialoceles, and Ranulas. Otolaryngol Clin North Am, 2021.PMID 34024482
[9]Mori T; Shimomura R; Himoto S; et al Neonatal suppurative parotitis: Case reports and literature review. Pediatr Int, 2022.PMID 33955624
[10]Pollenus J; Van Lierde S Neonatal Parotitis: A Case Report and Review of the Literature. Pediatr Infect Dis J, 2023.PMID 37171966