There are many childhood diseases that can have debilitating, if not fatal, consequences. One of them that requires immediate medical assistance before diagnosis is meningitis. But what is meningitis? What are early meningitis symptoms in toddlers that could indicate disease? How do doctors treat meningitis?

Meningitis: An Overview

What is Meningitis?

According to the Center for Disease Control (CDC), meningitis is a disease where the protective membranes covering the brain and spinal cord swell from inflammation. A bacteria or virus infecting these membranes and cerebrospinal fluid is the usual cause of the swelling.

Other causes include injuries, cancer, some drugs, fungi and parasitic infections. Accurate diagnosis of the cause of meningitis is critical to effective treatment. This is because different causes have very different treatment options.

The two most common causes of meningitis are bacteria and viruses. Other causes tend to be much rarer. In a general population, different people have different risks to meningitis, and it differs for both bacterial and viral meningitis.

Risk Factors For...

Bacterial Meningitis

Here are some risk factors that can show whether you are  at risk of bacterial meningitis:

• Age. Anyone can be affected by bacterial meningitis, and different bacteria affect different age groups. However, babies are more prone to getting the disease.

• Community. Infectious diseases tend to spread where the population is congested, such as N. meningitidis outbreaks in University campuses.
• Medical conditions. Certain medications and surgical procedures can be a contributing factor.
• Travel. Travelers are at a higher risk of contracting meningococcal disease when going to certain places, such as Mecca during the annual Hajj and Umrah pilgrimage.

Viral Meningitis

Viral meningitis shares risk factors with bacterial meningitis.

• Age. Anyone can contract the disease regardless of age. But those less than five years of age are more likely to be at risk.
• Weakened immune system. This increases the chances to contract the disease. Certain diseases, medications (such as chemotherapy), and recent organ or bone marrow transplants can cause the immune system to weaken.

Babies less than one month old and people with compromised immune systems are likelier to be more severely affected by the illness.

Why Are Children at Risk of Meningitis?

Children are are vulnerable to meningitis because their immune systems haven't learned how to tackle pathogens properly. Not taking vaccinations as scheduled massively escalates the risk of getting ill from meningitis. In addition, some people might be genetically vulnerable to getting the disease, too.

It is important to note that bacterial and viral meningitis are VERY different.

Bacterial vs Viral Meningitis

Bacterial infections, while uncommon, can be life-threatening. Viral infections, in comparison, are very common, but much less serious.

According to the National University Health of Singapore (NUH), most children are able to recover if viral meningitis has been treated. However, non-specific symptoms like malaise, dizziness and headaches can persist for weeks after successful treatment.  Other long-term effects after recovery include hearing impairment, as well as behavioural and learning issues. Thankfully, such effects are rare.

Meanwhile, bacterial meningitis can be fatal. Bacteria can cause septicemic shock, otherwise known as blood poisoning. This shock occurs because bacteria release toxins into the bloodstream. The resulting overwhelming immune response against these toxins damages blood vessels, leading to a red, spotty rash.

Children even die due to brain swelling. This happens when excessive pressure  is exerted on critical parts of the brainstem. Bacterial meningitis causes about 5% to 20% of deaths, depending on how dangerous the pathogen is. Other common complications that may arise are  electrolyte abnormalities and even seizures.

Now that you're aware of these dangers, you might worry about the next most important part...

Is Meningitis Contagious?

Different microorganisms spread in a variety of ways. In general, the bacteria or virus causing meningitis spreads from person to person by saliva. This means that coughing, sneezing, kissing or sharing cups and cutlery are risky activities. Certain pathogens can even spread through contaminated food. 

Here are a few examples of how the bacteria is spread:   

• Mothers infected with group B Streptococcus and Escherichia coli  can give the bacteria to their babies while in labor or during birth. 
• Haemophilus influenza B and Streptococcus pneumoniae are spread by air when people cough or sneeze. 
• Neisseria meningitidis travels by air or saliva. This typically happens by coughin,g kissing or close proximity (e.g. living under the same roof).

An Expert's Opinion on the Bacteria Contagion

Arthur Lavin, a peadiatrician who has had 25 years of experience and studied in Harvard, assures parents that the infection is extremely rare. Consider the fact that the bacteria that causes meningitis calls our noses and throats home. Yet in many cases, carriers don't get sick, and neither do those who are infected. The bacteria may spread between people, but it rarely develops into full-blown meningitis.

The same goes for the viruses responsible for meningitis. You would probably have been exposed to these viruses before the person even got sick. Furthermore, the virus will very likely not develop into meningitis — this is a very rare occurrence. It is much more likely that the virus will cause other milder diseases, such as stomach flu and fever.

Understanding the severity of this disease and its ability to spread are important first steps to expecting what's next. The next step is critical — it can mean the difference between life and death.

8 Early Meningitis Symptoms in Toddlers

A good thing about meningitis is that even if children are vulnerable to the disease, it has some very distinguishable features.

This is crucial to identify the strain of the disease and provide early treatment before it's too late for better recovery. Thus, parents, it is essential that you know how to identify meningitis.

Here are eight early meningitis symptoms in toddlers that parents need to watch out for. The symptoms in RED are ESPECIALLY serious. See here for a condensed table.

Symptom 1: Abrupt Fever

Parents need to look out for symptoms such as shivering and constant complaints of cold hands and feet. People who are sick also tend to experience a rapid rise in body temperature. However, parents, do note that fever is a symptom of many other diseases too.

Symptom 2: Rigid Occipital Muscles

The occipital muscle is a muscle group that covers the skull. Children who suffer from meningitis usually lie in an easily recognisable position: being on their sides, heads bent back, and legs bent inwards. More often than not, these children are also unable to straighten their necks.

Symptom 3: Inability to Unbend Legs

Another telltale early sign of meningitis in toddlers is the Brudziński neck sign. This abnormal position is characterized by children bending their heads close to their chest. Parents should be suspicious if the legs simultaneously bend at the knees when their heads are close to the chest, but are difficult to straighten.

Kernig’s sign, a symptom shown by the inability to completely extend one's leg when lifted perpendicular to the ground, should also be a red flag to parents.

Symptom 4: Fear and Sensitivity To Bright Light

Being afraid of bright light is also another key symptom of meningitis. Dazzling sources of light tend to worsen an unbearable headache, furthered by eyes watering and increased nausea.

Symptom 5: 'Unbearable' Headaches

Headaches caused by meningitis have been described as "unendurable." They are so painful that the pain may radiate towards the neck, but children won't notice any neck pains due to the sheer agony from the headache.

Symptom 8:  Skin Rashes

Skin rashes may also be a possible sign of meningitis. Parents can use the test outlined below to identify whether a rash is connected to meningitis or not.

Firstly, check the entire body. Locate tiny red or brown pin-prick marks which can change into larger red or purple blotches and blood blisters. If the skin is too dark to see such a rash, parents can also check the lighter areas like the palms of hands, or the soles of feet.

Take a transparent glass and apply it to the rash. Press the glass firmly on the skin affected by the rash until it turns pale. Spots that turn pale with the skin shows that the child is not suffering from meningitis. Parents should immediately seek medical help if they notice that the rash does not fade.

Other Important Symptoms to Take Note Of:

• Seizures
• Appearing to be confused or delirious 
• Limb/ joint/muscle pain that may accompany diarrhea or stomach pain
• Appearing irritable when picked up, with a high pitched or moaning cry
• Having a stiff body with jerky movements, or else floppy and lifeless
• Breathlessness
• Pale or mottled skin
• Sleepiness, or difficulty in waking up
• A soft part of the skull appearing swollen (or bulging fontanel) on your newborn's head.

* Note that fever is not a common symptom of meningitis in babies younger than than three months.

With meningitis, the earlier you identify the disease, the better your chances of recovery. This is because even if treatment is successful, children may still suffer from disabilities many years into the future.

Delayed Treatment and Post-Recovery Consequences

Early treatment is necessary in avoiding long term consequences. Delaying treatment  leads to death with septicemia, and even if prevented, debilitating consequences still ensue post-recovery. The Meningitis Research Foundation lists the following issues that meningitis survivors may suffer from:

• Memory loss, reduced focus, difficulty retaining information
• Coordination issues
• Headaches
• Deafness, hearing problems, tinnitus, dizziness and loss of balance
• Epilepsy/seizures
• Weakness, paralysis, spasms
• Speech problems
• Loss of sight

Septicemia can also cause:

• Memory loss, reduced focus, difficulty retaining information
• Coordination issues
• Arthritis or joint stiffness
• Scarring of the skin
• Amputations
• Kidney and lung damage

Numerous studies have shown that delaying treatment leads to unfavourable outcomes. One study in Papua New Guinea found that eight of 80 children died after being discharged. The survivors developed major neurological issues and multiple severe complications — leading to severe long-term disability. Numerous other studies also prove that surviving meningitis can result in permanent damage, hearing impairment, and a varying range of complications among a large group of children.

ANY Symptom needs URGENT medical attention

Preventing Meningitis

It is best to have different approaches to prevent meningitis since it has so many possible causes. Here, we recommend three different things parents can do: vaccinate their children, keep an eye out for symptoms, and teach them good hygiene practices at home.

Dr Thoon Koh Cheng, Head and Senior Consultant at the Infectious Disease Service, KK Women’s and Children’s Hospital (KKH) explains why it is also important to adhere to these practices. He explains that although vaccines are effective in stopping bacterial and viral meningitis, they aren't foolproof. It's still possible to get an infection, just that the risk is much, much less than not being vaccinated.

“It’s also important to have a high personal level of hygiene to prevent infections in general,” says Dr Thoon, hinting that we can't completely rely on vaccines only.

Vaccination

Although not compulsory, we encourage parents to consult their pediatrician to get advice on whether to vaccinate their children or not. People who travel, in particular, should get these jabs. This is especially helpful if they are entering places where the disease is rife, such as Africa, South America, and the Middle and Far East. Do get your vaccination at least a week before travelling.

Constant Vigilance

Know the symptoms and red flags so that you can immediately get the patients, or potential patients imminent treatment. Always keep a sharp eye out for family members and other people for early signs of illness, especially fever, and do not hesitate to call emergency services should you suspect meningitis.

The Royal Children's Hospital at Melbourne also encourages children to avoid cigarette smoke as it increases the risk of contracting meningitis.

Good Hygiene Practices

Practicing good hygiene will minimise the risk of contracting pathogens, and hence reduce the likelihood of spreading the disease. Teach your children to:

• thoroughly scrub their hands on a routine basis
• never share anything that is used for eating or drinking, like bottles, cups or cutlery
• close their mouth should they cough or sneeze, and to never use their elbow to cover these coughs
• dispose of  tissues in the trash can immediately after using them and to wash their hands afterwards

Remember parents, prevention is always better than a cure. Meningitis is relentlessly aggressive, unforgiving and it progresses very quickly. “Once damage sets in, treatment may no longer be effective. Or it can only save what has not been damaged,” says Dr Thoon.

Please get your kids vaccinated, get educated, and be hygienic. It's better to be safe than sorry.

You've done all you can to prevent and know more about meningitis. In the case that it does happen, it's also good to know how your children are going to be treated

What Can I Expect If My Child Gets Diagnosed with Meningitis?

Physical Check Up & Pre-treatment

The doctor will examine an array of factors when your child enters the emergency room. These include body temperature, pulse, respiratory rate, blood pressure and blood oxygen levels. The doctor will also check for breathing, circulation, and any changes in the child'smental condition. He or she will also examine if there is a centralised source of infection.

You may also notice that your doctor might:

• fit your child with an intraveinous (IV) drip. The IV drip is important because it helps to collect blood, provide fluids, and preserve stable blood pressure.
• provide antibiotics before a spinal tap if the doctor thinks that bacteria is causing the disease. This is essential in prolonging the child's life, as bacterial meningitis can become fatal very quickly.

Diagnostic Tests

Signs that indicate meningitis may prompt your doctor to conduct more tests on your child, including:

• A lumbar puncture, otherwise known as a spinal tap. This procedure does not endanger the child and is currently the only way to diagnose meningitis.
• Urine tests. This is done to check if their urinary tract has been infected.
• A chest X-Ray to examine whether the lungs are infected or not.
• A CT scan, which is occasionally needed if more serious symptoms like brain abscesses, tumours, or increased brain pressure present themselves or are likely symptoms.

Treatment & Managing Secondary Infections

Bacterial Meningitis

In cases of bacterial meningitis, the doctor will usually prescribe antibiotics via an IV drip to improve the child's condition before diagnosis, especially if there is blood poisoning. These antibiotics will be based on bacteria which other children suffer from when they have meningitis and what kind of antibiotic resistance profiles are known in the surrounding area.

Once doctors have a better understanding of what kind of bacteria is causing meningitis and what antibiotics they are not resistant to, they will modify the treatment plan accordingly. Also, if your child is allergic to these antibiotics, doctors will prescribe a suitable alternative so that these antibiotics won't trigger an unwanted reaction.

In really serious cases, your doctor may also give steroids to reduce the damage caused by the disease. The buildup of fluid can lead to intercranial pressure due to too much fluid being retained in the head.

You might see doctors or medical professionals nursing the child in a head up position of 20–30° in a quiet environment. This is done to lower intercranial pressure, and may include intubation and sedation if it complements the current treatment plan.

Viral Meningitis

Unlike bacterial meningitis, viral infections are much less serious. No medication is needed. Viral meningitis can be treated at home and will likely clear itself in two weeks with enough rest. If the pain becomes unbearable, painkillers and other medicines can be prescribed to ease symptoms.

Although antibiotics don't kill viruses, it is still normally injected where meningitis is suspected to delay the progression of the disease until a non-bacterial cause is confirmed.

Once treatment is finished...

Once your child has been discharged, your doctor may request for a follow up visit within 24 hours. This may be to assess his or her condition and discuss how to cope with the post-recovery symptoms, or disabilities, if any. Do note that if meningitis occurs again, the same emergency services and hospitalisation will be needed.

Afterword

We at theAsianparent hope that this article about early meningitis symptoms in toddlers has been helpful. Remember, a very ill person needs medical help even if there are only a few spots, a rash or no rash at all. Meningitis or septicaemia is like a ticking time bomb — a literal race against time. Any help can make all the difference.

This article has been republished with permission from theAsianparent Indonesia, and was translated and rewritten by Kevin Wijaya Oey.

For more information on Meningitis and its vaccination, watch here. 

Singhealth, Raffles Hospital (Umrah, Vaccine schedule), KK Childrens Hospital (Travel tips, vaccine schedule), Health Xchange, Royal Children's Hospital Melbourne, Journal 1, Journal of Tropical Paediatrics, BMJ Journals, Meningitis Centre Australia