Pediatric Meningitis: Signs and Symptoms (Nursing)

by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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    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.

    About the Lecture

    The lecture Pediatric Meningitis: Signs and Symptoms (Nursing) by Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN is from the course Neurologic Disorders – Pediatric Nursing.

    Included Quiz Questions

    1. Irritability
    2. Seizures
    3. Hypothermia
    4. Sunken fontanelle
    5. Abnormally stiff neck
    1. Signs and symptoms vary by age.
    2. Viral meningitis usually has more pronounced symptoms.
    3. Meningitis symptoms are most pronounced in neonates.
    4. The Brudzinski sign is most helpful in diagnosing those under three.
    1. Kernig sign
    2. Brudzinski sign
    3. Babinski sign
    4. Kehr’s sign
    1. Fever with an abrupt onset
    2. Altered mental status
    3. Vomiting
    4. Decreased sensation
    5. Nyctalopia

    Author of lecture Pediatric Meningitis: Signs and Symptoms (Nursing)

     Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

    Elizabeth Stone, PHD, RN, CPEN, CHSE, FAEN

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