00:00
Alright, let's talk about the common signs and symptoms of
meningitis and some of the more subtle signs and
symptoms you may see in children. As with most signs and
symptoms, the signs
and symptoms of meningitis vary a lot based on age and the
type of meningitis.
00:19
The neonates that are at quite high risk for meningitis
because they have some
unique ways they can actually obtain it from the mother, for
example, can also be
the most challenging to assess. And this is partially
because of their subtle signs
of illness and also obviously they are non-verbal and can't
tell you how they're
feeling. It's very important to understand how signs and
symptoms of illness in
general manifest in a neonate. Also, bacterial versus viral
meningitis present in
different ways. Bacterial meningitis will generally have
more pronounced
symptoms. The viral forms will have some of the same
symptoms, but generally a
lot more mild. Alright, let's talk about a neonate and how
they may present if they
have meningitis. They will likely have pretty subtle signs
and symptoms of
meningitis similar to if they have another serious illness
or infection. They
sometimes just present with decreased feeding or refusing
feedings. They may
have a fever but they may not. They may be lethargic or they
may be very irritable
and inconsolable. Their cry may be different, might be very
weak, for example.
01:30
Their neck is probably still going to be soft and supple
rather than stiff as you may
expect in older child. The neonate may have an abnormal
fontanelle finding so it's
super important that you include that fontanelle assessment
in a neonate especially
if you are suspecting meningitis. So, those abnormal
findings could include just a
fullness, a tenseness or a bulging fontanelle. All which
could indicate excess CSF
build-up or increased intracranial pressure. And finally,
the neonate could have
seizure activity which may or may not have been identified
as such at home
because their seizures are so much more subtle than the
seizures of older children.
02:20
Some unique things about neonate other than what was just
mentioned is that
sometimes the only signs and symptoms of illness initially,
especially the really
young neonate, is just decreased feeding. And, some will
actually have
hypothermia rather than fever so that just seem really odd
but know that that can
be a normal finding in a neonate with a serious illness. As
the infant gets older and
with young children, their symptoms may get a little more
pronounced so it still
may be febrile or afebrile, but they usually have more
pronounced nausea and
vomiting. Sometimes they have nausea and vomiting just from
changing positions,
for example, and sometimes giving them a prescription
medicine for vomiting that
usually works for everybody else just doesn't take it away.
That's always a red flag.
03:11
They may have pain that they complain about, but they may or
may not be able to
localize and tell you exactly where it is. They may also
have that irritability or
inconsolability or their parents may just report that there
is not acting themselves.
03:26
Their seizures, if they exist, will probably be a little
more prominent, a little more
obvious than the neonate seizures but they still may be
pretty subtle especially if
they're still an infant. They're like under age 1. They may
have a bulging fontanelle
if they're under 18 months and still have any open
fontanelles. And they may start
to show these classic signs and symptoms of meningitis such
as that nuchal rigidity
or the stiffness of the neck and pain. So again, this age
also, these younger children
and older infants beyond the neonatal stage are still unique
in that the classic
symptoms of meningitis as well as other serious illnesses
may not be completely
there or completely obvious so they can peak a little bit
mysterious and they can
require quite a bit of really strong assessment skills to
identify serious illness with
this age. The Brudzinski and Kernig signs which are signs
that are classically
tested for by some medical providers are not very helpful at
this age because
they're difficult to elicit and it's also difficult to get a
young child to cooperate with
those tests. I'm going to show you what those are in a
moment. What if the child
gets older and also becomes an adolescent? They're going to
be easier to assess but
they still may not be obvious. So, usually the older child
or adolescent will have a
more abrupt onset of fever, will have more pronounced pain
that they can tell you
about fortunately which may include a headache, neck pain,
photophobia, so eye
pain in response to light especially. They may have seizures
actually as the initial
sign of meningitis and vomiting and altered mental status.
Always investigate any
acute changes in mental status at any age. So, we often say
that the most likely
cause of altered mental status in children is hypoxia. It's
not always the case but the
one thing that is always true is it's always serious when
there's acute mental status
change. So, always take that seriously. Do a full
assessment, full vital signs, and
really investigate what's going on. Make sure you're aware
of what the baseline is
as far as alertness and reactivity based on history from the
family and based on
your knowledge of the person. Alright, let's review real
quick the Brudzinski and
the Kernig signs which are 2 things you'll hear about in
nursing school. You may
see on the NCLEX, but again they have limited usefulness in
children. The
Brudzinski sign is a sign that's tested for. It's basically
a sign to see if there's a
certain response to forced flexion of the neck to see if it
causes a reflex flexion of
the hips, which could indicate like irritation of the
meninges. It's something that
you'll see some providers still do especially in older
children and in adults if they
suspect meningitis. This is how it looks. The test for the
Kernig sign is considered
positive when a leg resist extension if the same hip is
flexed, just like this. So both
of these signs are considered helpful but not diagnostic for
meningitis. Some major
complications of meningitis, if it's not identified early or
if it's not treated, include
many many complications that are associated with the brain
or the neurologic
system such as developmental delays, abscesses in the brain,
weakness or
paralysis, seizures, language deficits, hearing loss, and
meningococcemia or
meningococcal sepsis which are both complications of
meningococcal meningitis.