Meningitis in Babies

Most parents get a sense of dread when they here the word ‘meningitis’ and although it can be extremely serious or life-threatening, a better understanding can lead to a much more relaxed life. The information within this page is to help you understand the full spectrum of the condition, as well as to ensure you know what to do if you suspect meningitis.


What is Meningitis?

Meningitis is an infection of the meninges, which are membranes that cover the brain and spinal cord, and it can occur in both adults and children. Once infected, these membranes swell. Viruses are responsible for most cases of meningitis (referred to by doctors as ‘viral meningitis’), but bacteria can also cause meningitis, which, although rare, can develop into a life-threatening medical emergency. The commonest cause of bacterial meningitis is a bacteria called Streptococcus pneumoniae. This infection can have long-term consequences or even prove fatal and so prompt treatment is necessary to minimize the risk of adverse outcomes.

The incidence of severe pneumococcal infection, including meningitis, has decreased significantly since the introduction of the pneumococcal vaccine. Babies under 2 months of age are at greater risk of getting meningitis, according to the American Academy of Pediatrics (AAP). It’s not known for sure why some babies get meningitis and others don’t, but they believe it could be related to immature immune systems.


Recognising Meningitis

The symptoms of meningitis in babies, initially, may not be that obvious or different from many other spells of illness. In some babies, the first signs and symptoms may appear nothing more than being irritable or tired. However, given that meningitis can become very serious very quickly, it is essential that parents are aware of its symptoms, so that they can seek medical care immediately if meningitis is at all suspected.


Video on Meningitis Symptons in Babies from St John’s Ambulance

The following video is a really useful quick guide to symptoms, taking just under 2.5 minutes to watch.


Emergency Contact

The video refers to getting emergency help. In Cayman, the emergency number is 911, not 999.

My Contact Details

My patients (or anyone who is worried about their baby) can call me directly on +1 (345) 326 7827 (it’s rare for me not to be available).


More on Symtoms

There are many symptoms that can indicate meningitis in babies but the most common symptoms include:

  • Bulging fontanel (the soft spot on top of the head). Caused by increased pressure or fluid in the brain
  • Fever. A high temperature is always a red flag for infection, but some babies, especially those under 3 months of age, may not have a fever
  • Cold hands and feet, especially with a warm body (torso)
  • Chills, which may include shivering, with or without a fever
  • Stiff neck. Babies sometimes hold their bodies in a stiff position and may also hold their head tilted back
  • Irritability and crying, especially when picked up, often due to a sore or stiff neck, muscle and body aches
  • Rapid breathing
  • Persistent vomiting
  • Refusing feeding
  • Extreme sleepiness or floppiness. It can sometimes be difficult to wake your baby
  • Red or dark rash or marks on the body



Glass Test

If your baby has a rash that doesn’t fade under a glass, it’s a sign of blood poisoning (septicaemia) caused by meningitis and you should get medical advice right away. The rash can be harder to see on dark skin. Check for spots on paler areas like the palms of the hands, soles of the feet, the tummy, inside the eyelids, and the roof of the mouth.


DON’T WAIT FOR THE RASH – Busting the Rash Myth



Lots of people use the rash as a real red flag but it is important to understand that not all meningitis patients develop a rash and in some it can emerge quite late. It is important to be aware of or mindful of the full range of symptoms, accepting that many can be associated with milder illness too. However, we all agree that it is better safe than sorry, given that prompt and aggressive treatment helps ensure a better outcome.


Treating Meningitis in Babies

Bacterial meningitis is treated with antibiotics. These are typically given intravenously in the hospital, requiring your child to be admitted to the paediatric ward at George Town Hospital (to which I and a number of other private paediatricians have admitting rights). You may have gone directly to George Town A&E, which I will sometimes advise directly. If you are registeted with me, I will be contacted to come and admit.

According to the American Academy of Pediatrics and studies, most babies who receive prompt antibiotic treatment recover completely. However, about 20 percent may be left with ongoing effects, including nervous system issues, hearing problems, learning disabilities, seizures, and paralysis. Because of the serious and rapidly progressing nature of bacterial meningitis, it is vital for us to treat early and aggresively to reduce the chances of these longer term effects.

Viral meningitis does not respond to antibiotics but most forms are not as serious as bacterial meningitis (except for Herpes Simplex Virus – HSV, in newborns), and the majority of babies will recover completely without complications.

Regardless of the type of meningitis though, all types of meningitis require prompt medical attention, assessment and treatment. Beyond actual antibiotics (for bacterial meningitis), babies may need extra hydration with IV fluids, pain relief, close monitoring, and periods of rest in order to make a full recovery.


Prevention of Meningitis

Meningitis cannot be prevented completely, in part because its causes are quite common viruses and bacteria that cause meningitis in only some infants. However, there are some precautions you can take that can significantly reduce the chances of a baby getting it.

Meningitis can be spread easily from person to person and so basic hygiene is important.

Herpes simplex viruses (HSV). These viruses cause cold sores. According to the World Health Organization (WHO), more than 65% of the world’s population has HSV, and many do not know it. HSV meningitis in babies can cause very serious problems and so the most important precaution you can take is to avoid kissing your baby if you suspect you have a cold sore developing.


Vaccines are key

Vaccines prevent many of the infections that can lead to meningitis. Your baby should have it’s full schedule of vaccines as outlined by the Centers for Disease Control and Prevention (CDC), Cayman Schedule or the British Immunisation Schedule (or as recommended by your paediatrician/pediatrician).


Vaccines cannot prevent all cases of meningitis. However, they help protect against several types of serious bacterial and viral meningitis, which can greatly reduce the risk of a baby getting the disease.

Hib (Haemophilus influenzae type b) vaccine

Before the Hib vaccine was available, this bacteria was the leading cause of bacterial meningitis. Today, infection with Hib has become much less common due to the vaccine. Hib vaccine is given at 2, 4, and 6 months of age, 15 months of age and again at 4 years. Hib vaccine is given either alone or in a combination vaccine.

Pneumococcal vaccine

Pneumococcus bacteria can cause meningitis and other serious infections, such as pneumonia. The pneumococcal vaccine is typically given at 2, 4, and 6 months of age, followed by a final dose at around 12 months of age.

Meningococcal vaccine

The most common type of meningococcal vaccine is known as the meningococcal conjugate vaccine (MCV4). This vaccine is usually not given to babies, but to children 11 years of age and older.

Meningococcal B Vaccine

The meningococcal B vaccine is routinely given in many countries including the United Kingdom but is not currently available free here in Cayman. However, it can be provided by one of the many private paediatricians, including myself. It is given at 2, 4 and 12 months of age.

Meningococcal C Vaccine

The meningococcal C vaccine is also routinely given in many countries including the United Kingdom but again not currently available free here in Cayman. However, again, it can be provided by one of the many private paediatricians, including myself. It is given at 13 months of age.

MMR vaccine

The MMR vaccine protects against measles, mumps, and rubella. Before this vaccine became available, mumps was a common cause of viral meningitis, especially in babies and children. Measles can also cause meningitis.The MMR vaccine is given at 12 to 15 months of age and again at 4 through 6 years of age.




If in Doubt – Find Out!

My patients (or anyone who is worried about their baby or child) can call me directly on +1 (345) 326 7827 (it’s rare for me not to be available). However, if you are already really worried, or your child is unresponsive, call 911.