Doctor's Notes on Meningitis in Children
Meningitis is an inflammation of the membranes that surround the brain and/or the spinal cord. The signs and symptoms meningitis in children are not always obvious because children can’t communicate symptoms reliably. The following is a list of possible symptoms in infants and/or children bacterial – caused meningitis that children’s caregivers may need to recognize as bacterial meningitis is considered a medical emergency. For infants younger than three months, signs and symptoms may include one or more the following:
- poor feeding,
- stiff neck,
- bulging fontanelle (swollen soft spot on top of the infant’s head) ,
- seizure activity,
- shock, and
- hypotonia (floppiness or decreased muscle tone).
Children older than one year of age may show the following classic symptoms:
- nausea and vomiting,
- neck stiffness or neck pain,
- Brudzinski sign (knees automatically brought toward body when neck is bent forward) ,
- Kernig sign (hips flexed 900 then unable to straighten lower legs) ,
- altered mental status,
- seizures, and
Symptoms of viral meningitis resemble those of the flu:
Some children may exhibit one or more bacterial meningitis signs and symptoms but they are usually less severe.
The cause of meningitis is mainly bacteria or viral organisms that reach the bloodstream and are able to get through the blood-brain barriers to reach the meningeal membranes.
Meningitis in Children Symptoms
In infants, the signs and symptoms of meningitis are not always obvious due to the infant's inability to communicate symptoms. Therefore, caregivers (parents, relatives, guardians) must pay very close attention to the infant's overall condition. The following is a list of possible symptoms seen in infants or children with bacterial meningitis (bacterial meningitis at any age is considered a medical emergency):
- Classic or common symptoms of meningitis in infants younger than 3 months of age may include some of the following:
- Classic symptoms in children older than 1 year of age are as follows:
- Nausea and vomiting
- Increased sensitivity to light
- Altered mental status (seems confused or odd)
- Seizure activity
- Neck stiffness or neck pain
- Knees automatically brought up toward the body when the neck is bent forward or pain in the legs when bent (called Brudzinski sign)
- Inability to straighten the lower legs after the hips have already been flexed 90 degrees (called Kernig sign)
Symptoms of viral meningitis most commonly resemble those of the flu (fever, muscle aches, cough, headache but some may have one or more of the symptoms listed above for bacterial meningitis), but the symptoms are usually considerably milder.
Meningitis in Children Causes
Bacteria and viruses cause the great majority of meningitis disease in infants and children. The most serious occurrences of meningitis are caused by bacteria; viral-caused meningitis is common but usually is less severe and, except for the very rare instance of rabies infection, almost never lethal. However, both bacterial and viral types of the disease are contagious.
Meningitis normally occurs as a complication from an infection in the bloodstream. A barrier (called the blood-brain barrier) normally protects the brain from contamination by the blood. Sometimes, infections directly decrease the protective ability of the blood-brain barrier. Other times, infections release substances that decrease this protective ability.
Once the blood-brain barrier becomes leaky, a chain of reactions can occur. Infectious organisms can invade the fluid surrounding the brain. The body tries to fight the infection by increasing the number of white blood cells (normally a helpful immune system response), but this can lead to increased inflammation. As the inflammation increases, brain tissue can start swelling and blood flow to vital areas of the brain can decrease due to extra pressure on the blood vessels.
Meningitis can also be caused by the direct spread of a nearby severe infection, such as an ear infection (otitis media) or a nasal sinus infection (sinusitis). An infection can also occur any time following direct trauma to the head or after any type of head surgery. Usually, the infections that cause the most problems are due to bacterial infections.
- Bacterial meningitis can be caused by many different types of bacteria. Certain age groups are predisposed to infections of specific types of bacteria.
- Immediately after birth, bacteria called group B Streptococcus, Escherichia coli, and Listeria species are the most common.
- After approximately 1 month of age, bacteria called Streptococcus pneumoniae, Haemophilus influenzae type B (Hib), and Neisseria meningitidis are more frequent. The widespread use of the Hib vaccine as a routine childhood immunization has dramatically decreased the frequency of meningitis caused by Hib.
- Viral meningitis is much less serious than bacterial meningitis and frequently remains undiagnosed because its symptoms are similar to the common flu. The frequency of viral meningitis increases slightly in the summer months because of greater exposure to the most common viral agents, called enteroviruses.
Other more rare causes of meningitis that are noninfectious are cancers, head injury, brain surgery, lupus, and some drugs. There is no person-to-person transmission from these relatively rare causes.
There are so many childhood diseases, infectious and noninfectious, that it would be impossible to list them all here. However, we will introduce some of the most common ones, including viral and bacterial infections as well as allergic and immunologic illnesses.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.