Meningitis in babies and children

What is meningitis? 

Meningitis is an infection (bacterial or viral) of the protective membranes that surround the brain and spinal cord (meninges). It can affect anyone but is most common in babies, young children, teenagers and young adults (NHS, 2019).

Meningitis can be very serious if not treated quickly. It can cause life-threatening blood poisoning (septicaemia) and result in permanent damage to the brain or nerves (NHS, 2019).

Symptoms

Meningitis symptoms can develop suddenly. While any or all (or almost none) of the symptoms may be present, symptoms can include:

• a temperature (fever) of 38°C or higher 
• nausea and vomiting 
• being irritable and lacking energy
• a headache
• a blotchy rash that doesn't fade when a glass is rolled over it (although this rash won't always develop) 
• a stiff neck
• a dislike of bright lights
• confusion
• drowsiness or unresponsiveness
• seizures (fits)  
• skin that’s pale and mottled
• aching muscles and joints
• breathing quickly
• cold hands and feet.

 (NHS, 2019)

Babies might also:

• refuse feeds
• show agitation and not wanting to be picked up
• have a bulging soft spot on their head (fontanelle)
• be floppy or unresponsive
• have an unusually high-pitched cry
• have a stiff body.

(NHS, 2019)

So, there are lots of symptoms of meningitis but every case is different. The symptoms can appear in any order and some might not appear at all (NHS, 2019).

What to do if you think your child has meningitis

Make sure you get medical advice as soon as you can if you're worried about your child. Trust your instincts; don’t just wait for a rash to appear (NHS, 2019).

Meningitis is a medical emergency. Call for an ambulance (999) or go to your nearest accident and emergency department if you suspect your child might be seriously ill. If you're not sure whether it's anything serious, ask for advice by calling NHS 111 or your GP (NHS, 2019).

What causes meningitis?

Anyone can get meningitis but some things make it more likely. Children who have not had immunisations to prevent meningitis are at much greater risk but vaccination is not a guarantee of protection. Factors include being under five years old, your living environment, passive smoking, being around large numbers of people and immune system problems (Meningitis Now, 2019a).

Meningitis has many different causes but viruses and bacteria are the most common.

How does a baby or child get meningitis?

Bacterial meningitis

• Bacterial meningitis can be caused by a number of different bacteria.
• No vaccine protects against all types of meningitis.
• Some meningitis-causing bacteria also cause septicaemia (blood poisoning).
• Children who have had meningitis can get a variety of after-effects. These include acquired brain injury, learning and behavioural changes, hearing loss, emotional changes and sight problems.

(Curtis and Nyquist, 2011; Meningitis Now, 2019b)

Meningitis-causing bacteria usually spread from between people. The way it spreads depends on the type of bacteria involved (CDC, 2021).

Babies can get some bacteria, such as group B Streptococcus (GBS), from their mothers during labour and birth. (The NHS does not routinely test for GBS in pregnant women.)

People who are coughing or sneezing nearby can spread bacteria to your child (NHS, 2019). People can also spread bacteria by kissing or through longer contact like you’d get from living in the same household (CDC, 2021).

Some bacteria can spread to your child via contaminated food or as a result of someone not washing their hands before preparing food for them (CDC, 2021). 

People can also be carriers, in other words they carry these bacteria in or on their bodies without this making them ill. Most carriers never become sick but can still spread the bacteria to others (NHS, 2019).

Viral meningitis

Viral meningitis isn’t usually life-threatening but it can make people feel very ill. It is also more common than bacterial meningitis.

• Viral meningitis is most common in babies and young children but anybody can get it.
• The symptoms of viral meningitis can be very similar to those of bacterial meningitis, so you must seek urgent medical help for your child if you’re worried.
• Enteroviruses are the most common cause of viral meningitis but many other viruses can cause it. Enteroviruses normally cause a mild stomach infection and can be avoided by good hand washing (Gov.uk, 2019; NHS, 2019).
• Viral meningitis is not thought to be contagious – nearly all are isolated cases.

(Meningitis Now, 2019c)

Viral meningitis has no specific treatment. Your child would usually receive treatment with fluids to make sure they’re well hydrated, and given painkillers and plenty of rest.

Antibiotics don’t work against viruses. Antibiotics are often started on admission to hospital if the cause of meningitis is not known (Meningitis Now, 2019c).

Most people fully recover from viral meningitis although it can be a slow process. Yet some people experience serious and life-changing after-effects (Meningitis Now, no date; Meningitis Research Foundation, no date).

Meningitis immunisation

A number of different vaccinations can protect against meningitis because it’s caused by several different infections (NHS, 2019). The NHS vaccination programme gives children most of the vaccinations that protect against meningitis-causing infections (NHS, no date). For example, mumps commonly caused viral meningitis before the MMR vaccine protected against it (Meningitis Now, 2020).

Read our article on vaccines that can help protect your child against meningitis.

The glass test

If you find a blotchy rash that does not fade when you press a glass firmly over it, this is a typical symptom of sepsis caused by meningitis (NHS, 2019). Yet this symptom doesn't always develop. Some other conditions can look similar, so a detailed assessment by an appropriate health worker is necessary.

This rash can also be more difficult to see on darker skin. So check paler areas, such as the tummy, the palms of the hands, soles of the feet, inside the eyelids, and the roof of the mouth, for the rash (NHS, 2019).

The rash often starts off looking like small, red pinpricks. You would then see it spread quickly and turn into red or purple blotches (NHS, 2019).

You must get medical advice for your child immediately if you find this rash on them.

Treating meningitis

If meningitis is suspected, your child will be admitted to hospital to have tests and possibly a stay in hospital.

Tests will normally confirm whether your child has meningitis and will check whether it arose from a viral or bacterial infection. Antibiotic treatment usually starts before a confirmed diagnosis because bacterial meningitis can be so serious. It will be stopped if your child has viral meningitis.

Your child might have tests that include:

• a physical examination
• a blood test for bacteria or viruses 
• a lumbar puncture – spinal fluid is taken to check for bacteria or viruses 
• a computerised tomography (CT) scan to see whether there are any problems with the brain like swelling.

 (NHS, 2019)

Treatment in hospital

If your little one has bacterial meningitis, they’ll receive hospital treatment so they can be closely monitored. Children with severe viral meningitis might also be treated in hospital.

Treatments might include intravenous antibiotics and fluids (to prevent dehydration), oxygen for any breathing difficulties, and steroid medication for any swelling around the brain (NHS, 2019).

Treatment at home

Normally, your child will be able to go home if their meningitis is mild and if it’s viral. This is because viral meningitis usually improves on its own in seven to 10 days and tends not to cause serious problems (NHS, 2019).

While your child recovers, try to make sure they get lots of rest, and take painkillers and anti-sickness medicine as advised.

Recovery from meningitis

Meningitis affects children in different ways. Recovery will depend on the type of meningitis they contracted, how quickly it was treated and the extent of any complications (NHS, 2019).

Many children make a full recovery. Others might need additional treatment and long-term support to help with any serious complications or after-effects of meningitis.