Meningitis warning signs in babies: the glass test and when to call 999
Meningitis is one of the few childhood illnesses where the difference between acting now and waiting a little longer can be the difference between full recovery and lasting harm. If you are reading this at 2am because something about your baby does not feel right, the most important message is this: trust your instincts, read the signs below, and do not hesitate to call 999. Getting checked and being reassured is always the right outcome. Not getting checked when you should have is the one we want to help you avoid.
What meningitis is and why speed matters
Meningitis is inflammation of the meninges, the membranes that surround the brain and spinal cord. It can be caused by bacteria or viruses. Viral meningitis is the more common form and is usually less severe. Bacterial meningitis is less common but far more dangerous and can become life-threatening within hours of the first symptoms.
Meningococcal disease, caused by the bacterium Neisseria meningitidis, is particularly serious because it can cause both bacterial meningitis and septicaemia (blood poisoning) at the same time. The bacteria attack the lining around the brain and can simultaneously enter the bloodstream, causing rapid and sometimes catastrophic deterioration.
Babies and young children under five are among the highest-risk age groups for bacterial meningitis, along with teenagers. A young baby's immune system is still developing and cannot fight off the infection as effectively as an older child or adult.
Early treatment with intravenous antibiotics dramatically improves outcomes. Every hour of delay can matter. This is why knowing the warning signs and acting on them quickly is so important.
Early signs in babies, which may appear before the rash
The first signs of meningitis in babies can look similar to many childhood illnesses, which makes them easy to dismiss. The difference is that with meningitis, your baby is likely to seem more seriously unwell than their symptoms might suggest on their own. These early signs can appear before any rash develops:
- A high fever, particularly one that is rising quickly or feels very sudden in onset.
- Your baby is unusually irritable and cries in a high-pitched or moaning way that sounds different from their normal cry. This is sometimes called a meningeal cry and reflects the pain caused by the inflammation around the brain.
- Your baby seems to dislike being picked up or touched. They may arch their back when you handle them, which can be a sign that movement or contact is causing pain.
- Your baby is refusing feeds and seems very unwell rather than just off-colour in the way a mild cold or virus might cause.
- Your baby is very drowsy and difficult to wake, or seems less alert and responsive than usual.
These signs on their own are not proof of meningitis, but they are the body's early warning signals. If you are seeing several of them together and your baby seems genuinely unwell, do not wait to see whether they improve. Call 111 or your GP urgently, or call 999 if your gut tells you something is seriously wrong.
Later and more specific signs in babies
As the illness progresses, some more specific signs can appear. If you see any of these, do not wait. Call 999 immediately.
- Bulging fontanelle: the soft spot on the top of your baby's head normally sits flat or dips very slightly inward. If it feels firm, tight or bulges outward, this can be a sign of increased pressure inside the skull caused by the inflammation of meningitis.
- Stiff neck: your baby resists tilting or turning their head, or seems to hold it in an unusual position. In older babies this may be obvious; in very young babies it can be subtle.
- Sensitivity to light: your baby seems distressed or unsettled by normal levels of light, screwing up their eyes or turning away from light sources they would not usually react to.
- Pale, mottled or blotchy skin: the skin may look patchy, with areas that look bluish or grayish alongside areas of normal colour, giving a marbled appearance.
- Cold hands and feet: your baby's extremities may feel cold even while the rest of their body is hot with fever. This is a sign that circulation may be affected.
- A dusky or bluish tinge to the lips: any blueness around the mouth is a sign that not enough oxygen is reaching the tissues and needs emergency attention immediately.
The rash and the glass test
One of the most well-known features of meningococcal disease is a purple or red rash. This rash appears because the bacteria in the bloodstream attack and damage the walls of blood vessels, causing bleeding under the skin. This gives the rash a distinctive appearance and behaviour that sets it apart from most other rashes.
The rash typically starts as small, flat, red or purple spots that look a bit like pinpricks. These can then spread and merge into larger, irregular blotches or bruise-like patches anywhere on the body. On darker skin tones the rash can be harder to spot on the surface of the skin. In these cases, check the palms of the hands, the soles of the feet, the inside of the eyelids, and the roof of the mouth, where the rash may be easier to see.
How to do the glass test
Take a clear drinking glass and press it firmly against the rash. Look through the glass at the rash while pressing. If the rash fades, lightens or disappears while you press, this suggests the spots are caused by dilated blood vessels, which is the case with most normal viral rashes. If the rash remains clearly visible through the glass and does not fade or change colour when pressed, this is called a non-blanching rash, and you should call 999 immediately.
If you are unsure whether the rash is fading or not, or if you cannot tell, call 999 anyway. It is always the right decision if you are uncertain.
There is one more thing you must know about the rash: it often appears later in the illness, not at the beginning. Your baby may be seriously ill with meningitis for several hours before any rash develops. Some babies never develop a rash at all. Do not wait for a rash before calling 999 if your baby has other warning signs. The rash, when it appears, is confirmation that the situation is a medical emergency. The absence of a rash does not mean your baby is safe.
When to call 999
This section covers the situations that require you to call 999 without delay. Please read each point carefully and in full.
Call 999 immediately if your baby has a rash that does not fade when you press a clear glass firmly against it. This non-blanching rash is a sign of bleeding under the skin caused by meningococcal disease and is a medical emergency.
Call 999 immediately if your baby has a bulging fontanelle combined with a fever and seems very unwell. A fontanelle that is firm and pushing outward is a sign of raised pressure inside the skull and must be assessed urgently by a doctor.
Call 999 immediately if your baby is very difficult to rouse, unusually limp or floppy, or unresponsive to your voice or touch. A baby who cannot be roused to normal wakefulness needs emergency care.
Call 999 immediately if your baby's skin is turning pale, mottled, blotchy or blue, especially around the lips. These are signs that circulation or oxygenation is being affected.
Call 999 immediately if your baby has a stiff neck alongside a high fever and other signs of serious illness.
Call 999 immediately if you are seriously worried about your baby and something tells you that they are very unwell, even if you cannot identify a specific symptom from this list. You know your baby. Your instinct is a valid reason to call.
Do not drive your baby to hospital yourself if you think they may have meningitis. Call 999 and let the paramedics come to you. The ambulance crew can begin treatment on the way to hospital and will alert the team so they are ready when you arrive.
While you are waiting for the ambulance: keep your baby warm and stay close to them. Tell the 999 operator clearly that you suspect meningitis. Keep monitoring your baby and give the operator any updates they ask for.
Vaccines that protect against meningitis
The NHS childhood immunisation schedule includes several vaccines that protect against the most common bacterial causes of meningitis. These vaccines have made a substantial difference to the number of babies who develop the most serious forms of the disease, but vaccination does not protect against every strain, which is why knowing the warning signs remains important.
- Meningitis B vaccine (Bexsero): this vaccine protects against group B meningococcal bacteria, the strain responsible for the majority of meningococcal disease cases in the UK. It is given at eight weeks, sixteen weeks and one year of age.
- Meningitis C vaccine: protection against group C meningococcal bacteria is included in the Hib/MenC vaccine given at one year and in the MenACWY vaccine offered to teenagers.
- Pneumococcal vaccine (PCV): this vaccine protects against Streptococcus pneumoniae, another bacterium that can cause meningitis. It is given at eight weeks, sixteen weeks and one year.
- Hib vaccine: this vaccine protects against Haemophilus influenzae type b, which used to be the most common cause of bacterial meningitis in young children before the vaccine was introduced. It is given as part of the 6-in-1 vaccine at eight, twelve and sixteen weeks, and in the Hib/MenC vaccine at one year.
Keeping your baby's vaccinations up to date is the single most effective protective step you can take. If your baby has missed any vaccinations, speak to your GP or health visitor about catching up.
Bacterial versus viral meningitis
Viral meningitis is more common than bacterial meningitis and is usually less severe. Many people with viral meningitis recover fully without specific medical treatment, though they may feel very unwell for a period of time and may need rest and pain relief. Viral meningitis is most often caused by enteroviruses, and there is no specific antiviral treatment for most types.
Bacterial meningitis is less common but far more serious. It requires immediate hospital assessment and treatment with intravenous antibiotics. Without prompt treatment, bacterial meningitis can cause lasting damage to hearing, vision, limbs and the brain, or can be fatal.
It is not possible to tell from symptoms alone whether meningitis is bacterial or viral. A doctor needs to examine your baby and may need to carry out blood tests and other investigations to determine the cause. This is exactly why any suspected case of meningitis must be assessed in hospital without delay. When bacterial meningitis is being treated in hospital, doctors will generally start antibiotic treatment before they have confirmed the diagnosis, because the risk of delaying treatment is greater than the risk of treating before confirmation.
Frequently asked questions
Does meningitis always cause a rash?
No. The characteristic purple or red rash of meningococcal disease can appear late in the illness or not at all. Many babies with bacterial meningitis have other warning signs, including a high-pitched cry, a bulging fontanelle, high fever, stiffness and drowsiness, long before any rash appears. Never wait for a rash before calling 999 if your baby has other signs of serious illness and you are worried.
What does the glass test show?
The glass test helps you identify a non-blanching rash. Press a clear drinking glass firmly against the rash and look through the glass while pressing. Most rashes fade or disappear under pressure because the blood inside the skin vessels is temporarily pushed away. A meningococcal rash does not fade, because it is caused by bleeding under the skin rather than dilated blood vessels. If the rash stays visible through the glass and does not fade or change colour when pressed, call 999 immediately. If you are unsure whether the rash is fading, call 999 and describe what you can see.
What is the difference between bacterial and viral meningitis?
Viral meningitis is more common and is usually less severe. Many people recover without specific medical treatment. Bacterial meningitis is less common but far more serious. It requires urgent hospital treatment with intravenous antibiotics and can become life-threatening within hours. It is not possible to tell from symptoms alone whether meningitis is bacterial or viral, which is why any suspected case must be assessed in hospital without delay.
How quickly does meningitis progress in babies?
Bacterial meningitis can progress very rapidly. In some cases, a baby can go from appearing unwell to a medical emergency within a matter of hours. This rapid progression is exactly why acting on the early warning signs, rather than waiting to see whether things improve, is so important. If you suspect meningitis, call 999 without delay. The paramedics will not think you are overreacting.
What does a meningitis rash look like?
The rash associated with meningococcal disease appears as small, flat, red or purple spots that can look like pinpricks, or as larger blotches under the skin that resemble bruising. It can appear anywhere on the body. The most important feature is that it does not fade when you press a clear glass firmly against it. On darker skin tones the rash may be harder to see on the body surface, so also check the palms of the hands, the soles of the feet and the inside of the eyelids.
Which meningitis vaccines does my baby get on the NHS?
The NHS childhood immunisation schedule includes four vaccines that protect against bacterial meningitis. The meningitis B vaccine (Bexsero) is given at eight weeks, sixteen weeks and one year. The 6-in-1 vaccine, given at eight, twelve and sixteen weeks, includes protection against Haemophilus influenzae type b (Hib). The pneumococcal vaccine (PCV) is given at eight weeks, sixteen weeks and one year and protects against pneumococcal meningitis. The Hib/MenC vaccine, given at one year, adds protection against meningococcal group C. Keeping all vaccinations up to date is the best protection you can give your baby.
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