Meningitis is an inflammation of the tissues that cover the brain and spinal cord. The inflammation sometimes affects the brain itself. With early diagnosis and proper treatment, a child with meningitis has a reasonable chance of a good recovery, though some forms of bacterial meningitis develop rapidly and have a high risk of complications.
Types of meningitis: viral and bacterial
Thanks to vaccines that protect against serious forms of bacterial meningitis, today most cases of meningitis are caused by viruses. The viral form usually is not very serious, except in infants less than three months of age and with certain viruses such as herpes simplex, which typically causes another serious infection. Once meningitis is diagnosed as being caused by a virus, there is no need for antibiotics and recovery should be complete. Bacterial meningitis (several types of bacteria are involved) is a very serious disease. It occurs rarely in developed countries (because of the success of vaccines), but when it does occur, children under the age of two are at greatest risk.
The bacteria that cause meningitis often can be found in the mouths and throats of healthy children. But this does not necessarily mean that these children will get the disease. That doesn’t happen unless the bacteria get into the bloodstream.
Children at higher risk of meningitis
We still don’t understand exactly why some children get meningitis and others don’t, but we do know that certain groups of children are more likely to get the illness. These include the following:
- Babies, especially those under two months of age (Because their immune systems are not well developed, the bacteria can get into the bloodstream more easily.)
- Children with recurrent sinus infections
- Children with recent serious head injuries and skull fractures
- Children who have just had brain surgery
- Children with cochlear implants
With prompt diagnosis and treatment, 7 out of 10 children who get bacterial meningitis recover without any complications. However, bear in mind that meningitis is a potentially fatal disease, and in about 2 out of 10 cases, it can lead to serious nervous-system problems, deafness, seizures, paralysis of the arms or legs, or learning difficulties. Because meningitis progresses quickly, it must be detected early and treated aggressively.
Notify your pediatrician immediately if your child displays any of the following warning signs:
- If your child is less than two months old: A fever, decreased appetite, listlessness, or increased crying or irritability warrants a call to your doctor. At this age, the signs of meningitis can be very subtle and difficult to detect. It’s better to call early and be wrong than to call too late.
- If your child is two months to two years old: This is the most common age for meningitis. Look for symptoms such as fever, vomiting, decreased appetite, excessive crankiness, or excessive sleepiness. (His cranky periods might be extreme, and his sleepy periods might make it impossible to arouse him.) Seizures along with a fever may be the first signs of meningitis, although most brief, generalized (so-called tonic-clonic) convulsions turn out to be simple febrile seizures, not meningitis. A rash also may be a symptom of this condition.
- If your child is two to five years old: In addition to the above symptoms, a child of this age with meningitis may complain of a headache, pain in his back, or a stiff neck. He also may object to looking at bright lights.
Treatment for meningitis
If, after an examination, your pediatrician is concerned that your child may have meningitis, she will conduct a blood test to check for a bacterial infection and also will obtain some spinal fluid by performing a spinal tap, or lumbar puncture (LP).
This simple procedure involves inserting a special needle into your child’s lower back to draw out spinal fluid. This is usually a safe technique in which fluid is sampled from the bottom of the sac surrounding the spinal cord. Signs of infection in this fluid will confirm that your child has bacterial meningitis. In that case he’ll need to be admitted to the hospital for intravenous antibiotics and fluids and for careful observation for complications.
During the first days of treatment, your child may not be able to eat or drink, so intravenous fluids will provide the medicine and nutrition he needs. For bacterial meningitis, intravenous antibiotics may be necessary for seven to twenty-one days, depending on the age of the child and the bacteria identified. If prolonged antibiotics are needed, your child may be able to continue receiving medication in the comfort of your own home. Most children with viral meningitis improve within seven to ten days without antibiotics. Children will typically recover at home with rest, fluids, and over-the-counter pain medications, although some might need to be treated in the hospital.
Some types of bacterial meningitis can be prevented with vaccines. Ask your pediatrician about the following vaccines.
Hib (Haemophilus influenzae type b) Vaccine
This vaccine will decrease the chance of children becoming infected with Haemophilus influenzae type b (Hib) bacteria, which was the leading cause of bacterial meningitis among young children before this immunization became available. The vaccine is given by injection to children at two months, four months, and six months, and then again between twelve and fifteen months of age. (Some combined vaccines may allow your doctor to omit the last injection.)
There are two kinds of meningococcal vaccines available in the US, but the preferred vaccine for children is called the meningococcal conjugate vaccine (MCV4). Although it can prevent four types of meningococcal disease, it is not routinely recommended for very young children, but rather for young adolescents (eleven to twelve years of age), or teenagers at the time they start high school (or at fifteen years old).
This vaccine is effective in preventing many serious infections caused by the pneumococcus bacteria, including meningitis as well as bacteremia (an infection of the bloodstream) and pneumonia. It is recommended starting at two months of age, with additional doses at four, six, and between twelve and fifteen months of age. Some children who have an increased susceptibility to serious infections (these high-risk children include those with abnormally functioning immune systems, sickle cell disease, certain kidney problems, and other chronic conditions) may receive an additional pneumococcal vaccine between ages two and five years.