Meningitis in children and babies: warning signs, the glass test and emergency action

The NHS describes meningitis as an infection of the protective layers that cover the brain and spinal cord. NHS inform says it is usually caused by a viral or bacterial infection, that viral meningitis is the most common and least serious type, and that bacterial meningitis is rare but can be very serious if not treated quickly. It can lead to life-threatening blood poisoning (septicaemia) and permanent damage to the brain or nerves.

Many bacteria and viruses can be responsible. NHS inform lists meningococcal bacteria (groups A, B, C, W, X, Y and Z), pneumococcal bacteria, Haemophilus influenzae type b, and viruses such as enteroviruses, mumps and herpes simplex. The infection is usually spread by people who carry the germs in the nose or throat without being ill themselves, through coughing, sneezing, kissing, sharing utensils, toothbrushes or vapes, or close contact.

The NHS says symptoms develop suddenly and can include a high temperature, very cold hands and feet, a stiff neck, joint and muscle pain, a severe headache that is getting worse, eye pain in bright lights, seizures, vomiting and diarrhoea, confusion, being very sleepy or difficult to wake, and spots or a rash that does not fade when pressed with a glass. Early symptoms can resemble flu, a stomach bug or a hangover.

Babies and children under 5 may also not want to feed, have a high-pitched, unusual cry, a stiff body or be floppy or unresponsive, or have a bulging soft spot on the top of the head. Meningitis Now notes that someone can get a lot worse very quickly, that symptoms can appear in any order and some may not appear, and that fever with cold hands and feet, drowsiness, severe muscle pain and pale blotchy skin are among common signs.

The NHS says the rash usually starts as small red pinpricks before spreading quickly and turning into red or purple blotches, and that it can be harder to see on brown or black skin, where you should check paler areas such as palms, soles, the roof of the mouth, whites of the eyes or inside the eyelids. NHS inform points to the glass test from Meningitis Now: press a clear glass firmly against the rash, and a rash that does not fade under pressure can be a sign of meningococcal septicaemia.

Meningitis Now stresses that a rash that does not fade under pressure is a medical emergency on its own, you do not need other symptoms such as fever to appear before getting help, and that the rash can start as a rash that fades and then change to a non-blanching one, so keep checking.

The NHS says to call 999 or go to A&E for a baby or child under 5 with any of the following, or any symptoms you are worried might be meningitis:

• a very high temperature: 38C or more in babies under 3 months, or 39C or more in babies 3 to 6 months

• a very low temperature below 36C, or feeling cold to the touch or shivery

• a weak, high-pitched or continuous cry

• a rash that does not fade when pressed

• not responding as normal, not feeding, floppy, difficult to wake or sleepier than usual

For a child aged 5 or over, the NHS says to call 999 or go to A&E for a very high or very low temperature, a very painful headache, confusion or slurred speech, a stiff neck and inability to look at bright lights, a rash that does not fade, a first seizure, or any worry that it might be meningitis. NHS inform says to phone 111 or contact the GP practice urgently if symptoms could be meningitis but you are not sure it is serious, or if you think you have been exposed. Meningitis Now says that early diagnosis can be difficult and if you have had advice and are still worried, to seek help again.

NHS inform says people with suspected meningitis usually need tests in hospital: a physical examination, blood tests, a lumbar puncture to sample spinal fluid and sometimes a CT scan. Because bacterial meningitis can be very serious, antibiotics will usually start before the diagnosis is confirmed and be stopped later if tests show a virus.

Treatments listed by the NHS and NHS inform include antibiotics and fluids given directly into a vein and oxygen through a face mask; NHS inform adds steroid medicine in some cases to reduce swelling around the brain. Bacterial meningitis is treated in hospital usually for at least a week, the NHS says, while viral meningitis tends to improve on its own in 7 to 10 days and can often be managed at home with rest, painkillers and anti-sickness medicine.

The NHS says children and teenagers are offered vaccines that protect against the main causes of meningitis, including MenB, MenACWY, pneumococcal, 6-in-1 and MMRV, and that it is worth checking that vaccinations are up to date. NHS inform says people who have had prolonged close contact with someone who developed meningitis, such as people living in the same house, may be offered a dose of antibiotics as a precaution, while brief contact does not usually need it.

UKHSA says people with meningitis and meningococcal meningitis should stay away from the setting until they do not have symptoms, and that the local health protection team should be contacted.

The NHS says viral meningitis does not usually cause long-term problems and most people make a full recovery. Bacterial meningitis is rarer but more serious and may cause hearing or vision loss, seizures, problems with movement and co-ordination, and problems with memory and concentration; it can be fatal. NHS inform notes that a person who has had meningitis will usually have a hearing test after a few weeks, and lists learning and behavioural difficulties, bone and joint problems and kidney problems among possible complications. The NHS names Meningitis Now and the Meningitis Research Foundation as support organisations.