Meningitis in Infants and Children

This page gives information on meningitis in infants and children including symptoms, diagnosis and treatment. Information is also given on causes of meningitis.

The following questions are answered:

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What is Meningitis?

Meningitis is inflammation of the covering of the brain (called the meninges). It is a serious infection in children, especially babies.

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What causes meningitis?

Meningitis in infants and children can be either:

  • Bacterial meningitis - this is caused by bacteria
  • Viral meningitis - this is caused by viruses - generally viral meningitis is less severe than bacterial meningitis

The bacteria that usually cause childhood meningitis are:

  • Pneumococcus (or Streptococcal pneumoniae)
  • Haemophilus influenzae type B - seen less since vaccination with Hib began
  • Meningococcus (or Neisseria meningitidis) - seen less since meningococcal vaccines introduced. Meningococcal infection, especially blood infection (septicemia), is often associated with a petechial (non blanching) rash
    Seek medical attention urgently if your child has fever and develops a petechial or purpuric rash.
  • E. coli - seen especially in newborn babies
  • Group B streptococcus - seen especially in newborn babies

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What are the symptoms and signs of meningitis in infants and children?

The symptoms of bacterial meningitis can vary depending on age.

Babies with meningitis may:

  • be irritable
  • have poor feeding
  • have a fever
  • have vomiting
  • have a bulging fontanelle (soft spot) - this is not always seen in meningitis and some well babies can have a bulging fontanelle without having meningitis

These are similar symptoms for other infections as well. In babies under 3 months of age, we don't take chances so if your baby is unwell with a fever, we will do the test for meningitis.

To help you, you can use BabyCheck to score your baby to see if she is seriously unwell or needs medical attention.

Toddlers under 18 months with meningitis may:

  • have irritability
  • have fever
  • be more drowsy than usual when awake
  • not be their usual self
  • have signs of pain, so crying or not wanting to be touched
  • have vomiting
  • have a bulging fontanelle (soft spot) - this is not always seen in meningitis and some well babies can have a bulging fontanelle without having meningitis

Children over 18 months of age with meningitis will usually have a stiff neck plus any of the following symptoms and signs:

  • irritability
  • fever
  • be more drowsy than usual when awake
  • not be their usual self
  • headache
  • not wanting to be in bright lights
  • vomiting

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Does a bulging fontanelle (soft spot) mean meningitis?

Not necessarily. I have seen babies who have prominent (bulging) fontanelles (soft spots) who are perfectly well. Not only that, many babies who do have meningitis do not have a bulging fontanelle - especially if they are not drinking and are a bit dehydrated.

If your baby has a bulging fontanelle and is well in every other way, particularly if your baby is alert and happy, then it is unlikely that anything too serious is going on. As long as your baby continues to behave normally and doesn't have new symptoms such as vomiting, then you could just wait and see what happens.

Causes of a bulging fontanelle that are serious are when the bulging fontanelle means there is high pressure in the brain - this can happen in meningitis in infants and in some other conditions. Because of the high pressure, babies are usually irritable, not interested in their surroundings or even drowsy when awake and they can be floppy or abnormally stiff. If your baby has a bulging fontanelle and any of these symptoms or new vomiting, seek urgent medical advice.

So a bulging fontanelle may be seen in meningitis in infants but is not always present.

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What is the difference between bacterial and viral meningitis?

Bacterial vs viral meningitis:

  • The organism causing the meningitis is a bacteria and not a virus - we can see the bacteria in the csf (spinal fluid) under the microscope
  • Viral meningitis symptoms as usually not as severe as bacterial meningitis symptoms, so children are not so sick
  • Antibiotics won't work for viral meningitis but the good news is that viral meningitis in children gets better by itself without specific treatment
  • Viral meningitis does not usually have any complications or long term effects

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How is the diagnosis of meningitis made?

Meningitis in infants and children is diagnosed by examining the spinal fluid (cerebrospinal fluid or csf). The csf is obtained by a lumbar puncture - a special needle is put into the back to obtain the fluid - it sounds scary but is a relatively easy and safe procedure in experienced hands.

A lumbar puncture is also referred to simply as an LP.

If there is childhood bacterial meningitis, the csf will have white blood cells and bacteria seen under the microscope. This confirms infection.


If there are cells under the microscope but no bacteria, and no antibiotics have been given, then this is probably a viral meningitis in the child.

A child with suspected meningitis will also have blood tests done as well as the lumbar puncture.

In some cases, a lumbar puncture can not be performed in the initial phase of the illness because you child will be too ill. In those cases, treatment is started as if there is meningitis and the lumbar puncture can be delayed until your child is more stable. In such cases, blood tests may help identify the organism causing the meningitis.

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What is treatment for meningitis?

The treatment of meningitis in infants and children is antibiotics, given intravenously. The length of time varies depending on the bacteria found and the age of the child but is usually at least 7 days and often up to 14 days (newborn babies may require 3 weeks of treatment).

If your child is drowsy or there is concern that there is an associated encephalitis (brain infection), aciclovir (acyclovir) may be added to the treatment as well as the antibiotic - aciclovir (acyclovir) is an antiviral medication that is useful in treating encephalitis caused by one particular virus (herpes simplex).

Dexamethasone, a steroid, is sometimes given as well for the first 48 hours of treatment - studies have shown that in some cases of meningitis, dexamethasone reduces the complication of hearing loss.

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Is meningitis contagious?

Meningitis in infants and children is not contagious in itself but some of the bacteria that cause meningitis can be spread. For that reason, if your child has meningitis caused by Haemophilus influenzae type B or by Neisseria meningitidis, close contacts will be given medication to prevent spread of the organism in the family.

Generally, only family and close contacts require this treatment - if you are unsure, the public health (communicable diseases) physician will be able to help as these are notifiable diseases and should be notified to the public health (communicable diseases) department.

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What are meningitis complications?

In the acute phase of the illness, meningitis in infants and children:

  • may cause seizures
  • may cause collections to form in the brain
  • may cause your child to lapse into coma
  • occasionally may even cause death - this is a serious infection so it's important to avoid delay in seeking help

Long term complications on meningitis in infants and children are usually related to some form of brain damage, including:

  • hearing loss. Damage to the hearing nerve is relatively common in meningitis and hearing loss is a result so hearing tests are routinely performed after a child has meningitis
  • learning difficulties. These may be subtle and not show up until school age. It is important you keep an eye on how your child is doing in school
  • motor difficulties, eg. difficulties with walking. After meningitis in infants less than one year, developmental progress is closely monitored until children are walking, at least.

Long term problems are more likely after meningitis in infants less than 1 year and particularly less than 1 month of age.

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Is there a bacterial meningitis vaccine?

There is not one vaccine against meningitis in infants and children but there are vaccines against the bacteria that commonly cause meningitis, so there are vaccines against:

  • Haemophilus influenzae type B (Hib)
  • Neisseria meningitidis (Meningococcal vaccine) - there are several types and usually what type is given per country depends on what type is most commonly seen in that country. In the United Kingdom and Canada, Meningococcal type C is given in the early months of life, whereas in New Zealand Meningococcal type B (MeNZB) was given during an epidemic but is no longer part of the routine schedule. In Australia, Meningococcal type C vaccine is given at 12 months of age, whereas in the United States, a meningococcal vaccine effective against 4 types of the bacteria is given to certain high risk groups only but after the age of 2 years.
  • Streptococcal pneumoniae (Pneumococcus) - many countries now have this as part of the routine infant immunization schedule

You can give your child the best chance of not getting meningitis by ensuring she is appropriately vaccinated (immunized). However, even with immunization, there is still a chance of a child developing meningitis so if your child has worrying symptoms, don't delay in seeking medical attention.

  • To read about the United States immunization schedule, click here
  • To read about the Canadian immunization schedule, click here
  • To read about the Australian immunisation schedule, click here
  • To read about the New Zealand immunisation schedule, click here
  • To read about the British immunisation schedule, click here
  • To read about the South African immunisation schedule, click here
  • To read about the Indian immunisation schedule, click here

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When to Seek Medical Help

If you have a baby less than 18 months of age who has a fever, please see your doctor if she:

  • is very irritable
  • is drowsy even when awake
  • is not feeding well
  • is vomiting
  • has a non-blanching rash

If you have an child who is over 18 months who has a fever, see your doctor if she:

  • is complaining of a headache
  • has a stiff neck
  • doesn't like bright lights
  • is drowsy when awake

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References

  • Bedford H, de Louvois J, Halket S, et al. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ 2001 Sep 8;323:533–6
  • Louvois J et al. Effect of meningitis in infancy on school-leaving examination results. Arch Dis Child 2007;92:959-962

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To go to the top of the Meningitis in Infants page, click here

To read about signs of Serious Illness in your Child, click here

To read about Normal Development, click here

To go to the Childhood Infections page, click here

To return to the Home page, click here


Last reviewed 5 June 2012

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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