In the late 19th century, a baby girl was born in Alabama, USA. Tragedy struck when, as a toddler, the girl developed a then-mysterious illness that left her blind and deaf. Fortunately, she was able to rise above it all, graduating from Radcliffe College and going on to be n influential writer, speaker, and advocate for the disabled.
I am, of course, talking about Helen Keller. And although we don’t know for certain the nature of her terrible illness, there’s every indication that it was most likely bacterial meningitis. It’s now largely a preventable and, to a certain extent, treatable disease; if left untreated, however, it certainly can and does cause the disabilities suffered by Ms. Keller—and more.
Perhaps due to a lull in routine vaccinations—some of which, as we’ll discuss, help prevent meningitis—the American Academy of Pediatrics recently spent some time focusing on this illness. We’ve talked about meningitis as it applies to pregnant women; let’s now turn our attention to the disease and its effects on infants and children.
Some Meningitis Basics
Meningitis refers to an infection of the lining of the brain and/or spinal cord; this lining is known as the meninges. In many cases, it spreads to the brain itself.
Different types of germs can cause meningitis. The infection is most commonly due to bacteria or viruses; for the most part, the bacterial infections tend to be more severe, although the herpes virus can also cause a severe meningitis. Which children are susceptible to which germs—and who will get the sickest—varies with age, method of exposure, and, to a large extent, the luck of the draw. Young newborns can get the meningitis germ from the mother. Other babies may get it through close contact with others. Older children may get meningitis (rarely) from a sinus infection, an injury, or hardware inserted into the body (such as a shunt used to drain fluid from the brain).
One of the problems with meningitis is that individuals can get very sick very quickly with it. Older children and adolescents may have a headache, stiff neck, or dark purple spots on their skin; fever is usually present but is not specific to meningitis. Infants, on the other hand, tell us even less; sometimes it’s just that their feeding is off, or they’re an unusual color, or they appear to be having difficulty breathing. Certainly, many are fussy. Generally, babies with meningitis get sicker more quickly than their older counterparts. Therefore, meningitis is not a “wait and see” disease! Calling your baby’s provider promptly may make all the difference.
Diagnosing, Treating and Preventing Meningitis
The only sure way to diagnose meningitis is to perform a lumbar puncture, better known as a spinal tap. Every board-certified pediatrician has done a lot of them, and in experienced hands, it’s generally a safe procedure. Make no mistake, however: It’s not something pediatricians do because they need to fulfill a certain lumbar puncture quota! Spinal taps are performed because there’s a major concern the infant or child has meningitis; because the symptoms can be so subtle and the consequences so devastating, providers who refer for lumbar punctures are seriously concerned about the patient’s well-being.
The baby’s spinal fluid is sent for tests in order to determine what is causing the meningitis. These tests can take some time—a couple of hours for some quick but nonspecific tests, and a few days for a definitive answer. For this reason, babies are started on intravenous antibiotics (plus treatment for the herpes virus if that’s what it might be). Meanwhile, they are monitored for serious illness, usually in the hospital. If all the tests come back OK, the medicines can be stopped and, assuming the baby is better, it’s usually thought to be one of the less harmful viruses. These generally need no additional treatment.
Treatment is good, but prevention is always better. About 30 years ago an immunization came along for Hemophilus, a germ that caused a large percentage of the meningitis in infants over 2 months and in toddlers. A decade and a half later, a vaccine for Pneumococcus, another common type affecting all ages, came on the market. They (along with the vaccine for Meningococcus, which more commonly affects teenagers) are now part of the routine schedule.
Your “To Do” List: Saying Yes!
Not every case of meningitis can be prevented (for one thing, we don’t have a vaccine for every type), nor can we prevent every complication for those who do contract the disease. But you can do a lot to avoid a bad case for your little one by simply working with your provider and following her recommendations. Providers may give the following advice:
- If you’re pregnant, say “Yes” to prenatal care. Your obstetric provider will test for group B Streptococcus, a cause of meningitis in newborns, a few weeks prior to your due date. He’ll also determine if you have any major risk for giving your baby the herpes virus at delivery.
- Talk to your baby’s provider about your little one’s risk for meningitis as well as determining when to call. Usually the older the baby, the more leeway you will have, but ill-appearing babies generally deserve a quick call.
- Say “Yes” to a lumbar puncture for your baby if your provider recommends it. If she says it needs to be done, it very likely does!
- Say “Yes” to a hospital stay for your baby and antibiotic treatment if it’s recommended. This sometimes needs to be accomplished a at a specialty hospital if your community hospital doesn’t take care of a lot of babies.
- By all means, say “Yes” to immunizations against the bacteria that can cause meningitis. Some of us are old enough to actually have seen the diseases prevented by these vaccines and have a big appreciation for what a major triumph these shots represent.
Helen Keller actually lived quite a long time—well into the antibiotic and early vaccine eras. Although I certainly can’t speak for her, I would guess that she more than anyone appreciated the life- and health-preserving power of the advances in medicine during her lifetime. And I suspect she’d agree that meningitis is nothing to fool with. Do all you can to avoid the disease and its consequences in your baby.