From the Guidelines
Meningitis in children is a medical emergency that requires immediate attention, and parents should watch for signs such as high fever, severe headache, stiff neck, sensitivity to light, and irritability, as well as a distinctive rash that doesn't fade when pressed with a glass, which may indicate bacterial meningitis. According to the most recent and highest quality study 1, the classical signs and symptoms of bacterial meningitis, including fever, altered mental status, and neck stiffness, are less frequently present in younger infants compared to older children and adults.
Key Signs and Symptoms
- High fever
- Severe headache
- Stiff neck
- Sensitivity to light
- Irritability
- Bulging fontanelle (soft spot) in infants
- Poor feeding
- Unusual high-pitched crying
- Lethargy
- Nausea and vomiting in older children
- Confusion and difficulty concentrating
- A distinctive rash that doesn't fade when pressed with a glass (the "glass test")
The study 1 also notes that fever is the most commonly reported symptom in childhood bacterial meningitis, with an occurrence rate of 92-93%, and that vomiting is reported in 55-67% of children with bacterial meningitis.
Importance of Early Treatment
If you suspect meningitis, seek emergency care immediately, as early treatment significantly improves outcomes 1. Bacterial meningitis requires prompt antibiotic treatment, typically with ceftriaxone or vancomycin administered intravenously in a hospital setting. The inflammation of the meninges (protective membranes covering the brain and spinal cord) causes these symptoms, and quick medical intervention is crucial to prevent serious complications such as brain damage, hearing loss, or even death.
Diagnosis and Treatment
Diagnosis should be relatively straightforward if the child has fever and a classic non-blanching petechial or purpuric rash 1. However, children may present early with non-specific symptoms, often to their general practitioner, and half of all children with meningococcal disease are sent home at first presentation, illustrating the importance of reassessment of children with non-specific febrile illness. Administer parenteral antibiotics and arrange urgent hospital assessment if a generalized petechial rash or a purpuric rash is present 1.
From the Research
Signs of Meningitis in Children
The signs of meningitis in children can be similar to those of other conditions, making it challenging to diagnose. Some common signs include:
- Fever
- Headache
- Stiff neck
- Vomiting
- Confusion or disorientation
- Seizures
- Rash (in some cases)
Clinical Prediction Rules
Several studies have attempted to develop clinical prediction rules to help identify children with suspected bacterial meningitis 2. However, a rigorously developed and well-validated rule ready for clinical use has not been identified. The Bacterial Meningitis Score has shown promise, but further prospective validation is needed.
Laboratory Tests
Laboratory tests, such as cerebrospinal fluid (CSF) culture and inflammatory markers (e.g., procalcitonin), can help distinguish between bacterial and viral meningitis 3. CSF culture is considered the gold standard for diagnosing bacterial meningitis.
Treatment
Bacterial meningitis requires prompt antibiotic treatment. Ceftriaxone is a commonly used antibiotic for treating bacterial meningitis in children, and it can be administered once daily 4, 5. The duration of treatment may vary, but studies have shown that 5 days of treatment with ceftriaxone can be effective in some cases 6.