Meningitis in Babies: Symptoms, the Glass Test, and When to Call 999

Meningitis is inflammation of the meninges — the membranes surrounding the brain and spinal cord. It is one of the most serious illnesses a baby can develop and requires immediate medical attention. Knowing the symptoms, understanding the glass test, and recognising when to call 999 could save your child's life.

This guide is about recognising and responding to meningitis in babies and young children. If you are reading this because you are concerned about your child right now, stop reading and call 999.

Bacterial vs Viral Meningitis

Meningitis can be caused by viruses or bacteria.

Viral meningitis is far more common and is usually less severe. Most people with viral meningitis recover fully without specific treatment, though the illness can be very unpleasant and frightening.

Bacterial meningitis is rarer but is a life-threatening emergency. It can progress from first symptoms to death within 24 hours. The most common bacterial causes in the UK are:

• Neisseria meningitidis (meningococcal bacteria) — responsible for meningococcal disease, which includes both meningitis and septicaemia
• Streptococcus pneumoniae (pneumococcal bacteria)
• Group B streptococcus (GBS) — a major cause in newborns
• Listeria monocytogenes — rare, mostly affects newborns and immunocompromised individuals

Bacterial meningitis is often accompanied by septicaemia (blood poisoning), which produces the characteristic rash and is the most immediately life-threatening element.

Symptoms in Babies

Babies cannot tell you they have a headache or that the light hurts their eyes. Their symptoms are different from those in older children and adults.

Early symptoms (may appear within hours)

• High temperature — but note that some babies with meningitis have a normal or low temperature
• Cold hands and feet despite a fever
• Pale, blotchy, or mottled skin
• Refusing feeds or feeding very poorly
• High-pitched, unusual cry — different from a normal hungry or tired cry
• Excessive drowsiness — difficult to wake, unresponsive
• Irritability — not consoled by normal comforting
• Stiff body, or floppiness — loss of normal muscle tone

Signs that indicate serious illness

• Bulging fontanelle — the soft spot on top of a baby's head normally feels flat. A tense or bulging fontanelle (when your baby is upright and not crying) can indicate raised pressure inside the skull
• Dislike of bright light (photophobia) — your baby may turn away from light or become more distressed in a bright room
• Neck stiffness — resistance when you gently try to bring the chin towards the chest; in babies this can be subtle
• Seizures

The rash

The characteristic rash of meningococcal disease is a non-blanching rash — meaning it does not fade when pressed. It appears as small, flat, red or purple spots that look like tiny bruises or blood spots under the skin. These are called petechiae (if small) or purpura (if larger). As the condition progresses, the spots can merge into large, blotchy patches.

The rash may not appear at all, or may appear late. Do not wait for a rash to develop before calling 999. A baby can have bacterial meningitis without any rash.

The Glass Test

Press a clear glass firmly against the rash. If the spots or marks fade and disappear under pressure, it is likely to be a blanching rash — less concerning. If the marks remain clearly visible through the glass, it is a non-blanching rash and you must call 999 immediately.

The glass test only tells you about the rash. It tells you nothing about whether meningitis is present in the absence of a rash. A child can be critically ill with bacterial meningitis and have no rash at all.

A note on the image

You may have seen images of the glass test on the Meningitis Research Foundation or NHS websites. These show a purple, blotchy rash through a glass tumbler — the rash remains visible under the glass. Keep the image in mind, but do not rely solely on recognising the rash. Trust the other symptoms.

When to Call 999

Call 999 immediately if your baby:

• Has a non-blanching rash
• Is extremely difficult to wake or unresponsive
• Has a bulging fontanelle
• Is having a seizure
• Has blue or grey lips
• Is breathing abnormally
• Is floppy and unresponsive

Call 999 without waiting for all symptoms to appear. Meningitis can progress with extraordinary speed. If your instincts tell you something is seriously wrong with your baby, act immediately.

Do not drive to hospital yourself if your baby is very unwell — call 999 so an ambulance can begin treatment en route.

UK Vaccinations That Protect Against Meningitis

The UK childhood vaccination schedule provides protection against several of the bacteria that cause meningitis. These are given as part of the routine NHS programme.

Vaccinations and what they cover

• 6-in-1 vaccine (at 8, 12 weeks, 1 year) — includes protection against Haemophilus influenzae type b (Hib), a bacterial cause of meningitis
• Pneumococcal vaccine / PCV (at 12 weeks, 1 year) — protects against pneumococcal meningitis
• Men B vaccine (at 8 weeks, 16 weeks, 1 year) — protects against meningococcal group B, the most common cause of bacterial meningitis in UK infants
• Men ACWY vaccine (given to teenagers and, via maternal immunisation, to newborns via the pregnant woman's vaccination) — protects against meningococcal groups A, C, W, and Y
• Hib/Men C booster (at 1 year) — boosts protection against Hib and meningococcal C

It is important to note that these vaccinations significantly reduce risk but do not eliminate it entirely. Vaccinated children can still develop meningitis caused by strains not covered by the vaccine, or in rare cases, despite vaccination. Immunisation reduces risk — it does not remove the need for parents to be vigilant.

Meningitis Research Foundation (www.meningitis.org) has excellent resources including a free helpline (0808 80 10 388) for families who want more information or support after a diagnosis.

What to Do

If you are concerned that your baby may have meningitis:

1. Do not wait for all symptoms to appear
2. Do not wait to see if the rash develops
3. Do not give extra paracetamol and hope for improvement
4. Call 999 and describe your concerns clearly

Early treatment with intravenous antibiotics dramatically improves outcomes in bacterial meningitis. The earlier treatment begins, the better the chance of full recovery without complications.

If you call 111 or your GP and remain worried, trust yourself. You can always call 999.