Pediatric Meningitis

Meningitis is a swelling (inflammation) of the thin membranes that cover the brain and the spinal cord. These membranes are called the meninges.

Meningitis is most often caused by a bacterial or viral infection that moves into the cerebral spinal fluid (CSF). CSF is the fluid that protects and cushions the brain and spinal cord. A fungus or parasite may also cause meningitis. This is more common only in children with a weak immune system.

Meningitis caused by a virus is more common and usually less severe. Bacterial meningitis is usually more severe and may lead to long-term complications or death.

Viruses that can cause meningitis include the herpes simplex virus, the mumps virus (paramyxovirus), the flu virus and West Nile virus.

Bacteria that can cause meningitis include group B streptococcus, E. coli, Haemophilus influenzae type b (Hib) and a strep bacteria that causes pneumonia. Syphilis, tuberculosis, and Lyme disease bacteria can also cause meningitis.

The bacteria, viruses and fungi that cause meningitis usually grow in a person’s respiratory tract. A child may have no symptoms at all but may carry the organism in his or her nose and throat. They may be spread by:

• Close contact with someone carrying the infection
• Touching infected objects, such as doorknobs, hard surfaces, or toys, and then touching nose, mouth or eyes
• Droplets from a sneeze, close conversation or kissing

An infection usually starts in the respiratory tract. In a child, it may first cause a cold, sinus infection or ear infection. It can then go into the bloodstream and reach the brain and spinal cord.

A child is more at risk for meningitis if he or she has an infection caused by a number of viruses, bacteria or fungi. Children with a weakened immune system are at great risk.

The symptoms of meningitis vary depending on what causes the infection and the age of the child. The symptoms may start several days after your child has had a cold and runny nose, or diarrhea and vomiting. Symptoms can occur a bit differently in each child. Symptoms may appear suddenly. Or they may develop over several days.

In babies, symptoms may include:

• Irritability
• Fever
• Sleeping more than usual
• Poor feeding
• Crying that can’t be soothed
• High-pitched cry
• Arching back
• Bulging soft spots on the head (fontanelles)
• Changed temperament
• Purple-red splotchy rash
• Seizures
• Vomiting

In children age 1 or older, symptoms may include:

• Neck pain
• Back pain
• Headache
• Sleepiness
• Confusion
• Irritability
• Fever
• Refusing to eat
• Reduced level of consciousness
• Seizures
• Eyes sensitive to light (photophobia)
• Nausea and vomiting
• Neck stiffness
• A purple-red splotchy rash

The symptoms of meningitis can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Your child's healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. Your child may also have tests, such as:

• Lumbar puncture (spinal tap). This is the only test that diagnoses meningitis. A needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain is measured. A small amount of CSF is removed and sent for testing to see if there is an infection or other problems.
• Blood tests. These can help diagnose infections that cause meningitis. 
• CT scan or MRI. These are tests that show images of the brain. A CT scan is sometimes done to look for other conditions that may cause symptoms like those of meningitis. An MRI may show inflammatory changes in the meninges. These tests give more information. But meningitis can’t be diagnosed using these tests alone.
• Nasal, throat or rectal swabs. These tests help diagnose viral infections that cause meningitis.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Treatment varies by type of meningitis. The treatments by type include:

• Bacterial meningitis. Treatment is started as quickly as possible. Your child's healthcare provider will give your child IV (intravenous) antibiotics, which kill bacteria. Your child will also get a corticosteroid medicine. The steroid works by decreasing the swelling (inflammation) and reducing pressure that can build up in the brain. Steroids also reduce the risk for hearing loss and brain damage. 
• Viral meningitis. Most children get better on their own without treatment. In some cases, treatment may be done to help ease symptoms. There are no medicines to treat the viruses that cause viral meningitis. The only exception is herpes simplex virus, which is treated with IV antiviral medicine. Babies and children with a weakened immune system may need to stay in the hospital.
• Fungal meningitis. Your child may get IV antifungal medicine.
• Tuberculous (TB) meningitis. Your child will be treated with a course of medicines over one year. Treatment is done with several medicines for the first few months. This is followed by other medicines for the remaining time.

While your child is recovering from meningitis, he or she may also need:

• Bed rest
• Increased fluid intake by mouth or IV fluids in the hospital
• Medicines to reduce fever and headache. Don’t give aspirin or medicine that contains aspirin to a child younger than age 19 unless directed by your child’s provider. Taking aspirin can put your child at risk for Reye syndrome. This is a rare but very serious disorder. It most often affects the brain and the liver.
• Supplemental oxygen or breathing machine (respirator) if your child has trouble breathing

Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all treatments.

Bacterial meningitis is usually more severe and may lead to long-term complications. Some children may have long-term problems with seizures, brain damage, hearing loss and disability. Bacterial meningitis can also cause death.

Several vaccines are available to prevent some of the bacterial infections that can cause meningitis. These include:

• H. influenzae type b vaccine (Hib). This is given as a 3- or 4-part series during your child's routine vaccines starting at 2 months old.
• PCV13 pneumococcal vaccine. The American Academy of Pediatrics recommends this vaccine for all healthy children younger than age 2. PCV13 can be given along with other childhood vaccines. It is recommended at ages 2 months, 4 months, 6 months, and 12 to 15 months. One dose is also advised for older children who did not get the 4-dose series and for those at high risk for pneumococcal disease.
• PPSV23pneumococcal vaccine. This vaccine is also recommended for older children at high risk for pneumococcal disease.
• Meningococcal vaccine. This vaccine is part of the routine vaccine schedule. It is given to children ages 11 to 12, with a booster given at age 16. It is given to teens entering high school if they were not vaccinated at age 11 or 12. A booster is also given at age 16 to 18, or up to 5 years later. Babies and young children at increased risk may also have this vaccine. Ask your child's healthcare provider about the number of doses and when they should be given.

Vaccines that protect against viruses such as measles, mumps, chickenpox and the flu can prevent viral meningitis.                                       

Talk with your child’s healthcare provider if you have questions about the vaccines.

You and your child can do other things to prevent the spread of infections. Correct handwashing and staying away from people who are sick can help prevent meningitis.

Call your child's healthcare provider if your child has:

• Not received vaccines
• Contact with someone who has meningitis
• Symptoms that don’t get better or get worse
• New symptoms