Meningitis in children

ADAM is a four-month-old boy. He had a chesty cough and runny nose for a week and developed a high fever two days before he was rushed to the hospital.

He became cranky and less active, cried a lot and refused to drink milk. Adam then had a seizure that involved jerking movements of his four limbs and his eyes rolling back in his head. It lasted about five minutes, and his parents brought him to the hospital immediately.

At the hospital, a paediatrician diagnosed Adam with pneumonia, complicated with meningitis. His extremely worried parents were advised to admit him, so he could undergo lab tests and imaging studies and be started on intravenous antibiotics.

What is meningitis

Meningitis is the inflammation of the membrane covering the brain and spinal cord (meninges). Children who get meningitis can deteriorate and become very ill very fast and eventually die.

If dealt with quickly, meningitis can be successfully treated, so it is important for parents to understand meningitis, know its common symptoms and get their child assessed and treated immediately if they suspect he has meningitis.

Meningitis can be caused by:

> Bacteria: Pneumococcus, meningococcus, haemophilus influenzae type B, streptococcus, E.coli, salmonella

> Viruses: Enteroviruses, mumps virus, herpes simplex

> Fungi

> Tuberculosis

Most of these pathogens are spread through cough droplets, nasal secretions, saliva, urine, faeces or the contaminated daily utensils of those infected.

In the beginning, these pathogens cause coughing, runny nose, vomiting or diarrhoea by affecting the airway, lungs, stomach and gut of an infected child, after which they further invade and spread to the meninges and brain via the bloodstream.

Prevention

Current vaccinations help prevent most of these pathogens. Parents should consult and discuss with their pediatrician to ensure their child’s vaccinations are being administered according to his vaccination schedule.

Besides that, parents should maintain good hygiene for and around their child through frequent hand-washing, sterilising the child’s feeding bottle, spoons and plates, and properly storing and preparing the child’s food and drink to prevent contamination.

Symptoms

A child who has meningitis can develop symptoms such as high fever, poor appetite, vomiting, headache, neck stiffness, irritability, lowered activity, inconsolable crying, confusion, abnormal behaviour and seizures. These symptoms can occur in any order.

You know your child best, so check on them often when they are sick, trust your instincts and act fast if he needs medical care.

Medical care

At the hospital, your paediatrician will perform a full medical assessment and examination on your child. If your child is diagnosed with meningitis, medical investigations may include blood tests, blood culture and a lumbar puncture to collect cerebral spinal fluid to assess for meningitis.

A CT scan of the brain will help diagnose and assess the severity of meningitis in the child and detect complications such as brain abscesses. Intravenous antibiotics will be started immediately without delay.

Many parents worry about lumbar punctures, but it is a safe medical procedure. The paediatrician will give your child some medication to ensure he or she is a sleep and the procedure is done without pain. A small needle is used to collect a sample of cerebral spinal fluid from your child’s lower back for the diagnostic assessment of meningitis.

Delayed treatment of meningitis can cause death and lead to many neurological complications such as delayed development, hearing impairment, movement disorders, learning disabilities and cerebral palsy. Parents should seek immediate medical attention for their child if they suspect their child has symptoms of meningitis.

Adam was treated successfully with intravenous antibiotics in the hospital for two weeks. His final lumbar puncture showed that his cerebral spinal fluid was clear of the bacteria. He was discharged and allowed to go home, to the gratitude and joy of his parents.

Adam now undergoes follow-up appointments at the paediatric clinic to assess his neurological development and hearing and learning abilities.

Dr Lai Eng Meng is a consultant paediatrician at ParkCity Medical Centre. For more information, call 03-5639 1212.