Report highlights meningitis being missed

• Management of children with early stages of bacterial meningitis could be improved, according to a new report
• National guidelines recommend doctors give parents ‘safety netting’ information  if sending home a child with suspected infection – report shows this does not always happen
• Charity is calling for an audit of the guidelines to improve rapid meningitis diagnosis and treatment
• Sign the petition to ensure that babies and children with bacterial meningitis receive the correct treatment as soon as possible: https://petition.parliament.uk/petitions/228720  

Lives could be saved if parents are given consistent, explicit advice about recognising meningitis and septicaemia (otherwise known as sepsis) from health professionals, according to a new report from the charity Meningitis Research Foundation.

The report, launched at the start of Meningitis Awareness Week, says almost a third (30%) of young babies with bacterial meningitis receive inappropriate early treatment which delays parents seeking further help, and around half (49%) of children who have meningococcal infection - the most common cause of bacterial meningitis - are sent home after their first visit to a GP and not admitted to hospital.

This is because the early signs of meningitis and sepsis are often similar to the symptoms of less serious illnesses, making these serious conditions very difficult to spot at first.

National clinical guidelines recommend that doctors listen to parents concerns because they know their child best, and recommend that 'safety netting' information is given to parents or carers of sick children with suspected infection before they are sent home.

This should include information about meningitis and sepsis and tell parents to return for medical help if they feel their child’s symptoms do not improve or are getting worse. In reality this information is not always give.

A child with meningococcal meningitis or septicaemia usually displays only non-specific symptoms in the first 4-6 hours of illness but could be close to death within 24 hours.

The report includes a summary of personal accounts of over 100 parents whose children had meningitis but were sent home after their first visit to a health professional.

In one study the report highlights, examples of inappropriate advice given to parents included, being told that their child’s fever was due to a change in milk formula, or where prune juice was recommended for fever and irritability.

Mum of two, Kirstie Walkden, from Manchester said, “In August last year our nine month old baby girl became critically ill. Amy had seemed a bit out of sorts for a day or two. I took her to A&E on the Sunday when her symptoms escalated; temperature, vomiting, mottled skin, fast breathing, lethargic. However, we were sent home with antibiotics for a suspected ear infection. I was surprised but felt reassured.

“Back at home her temperature continued to soar and by the Tuesday she was no longer eating or drinking and I couldn’t get any normal response from her. My instincts were screaming this was serious so I made the decision to take her back to hospital - where all hell broke loose. This time the hospital were amazing and within an hour they were treating her for suspected meningitis and sepsis. The diagnosis was later confirmed as pneumococcal meningitis. We were living a nightmare and pleading for her to keep on fighting, and on day 18 she was finally well enough to come home.

“Only time will tell what long term impact the disease has had on her, but so far she has exceeded all expectations. I shudder to think what could have happened if I’d not trusted my instincts and gone back so soon.”

Vinny Smith, Chief Executive of Meningitis Research Foundation said: “There’s a real risk that doctors can easily miss meningitis and sepsis in the early stages. Offering patients or parents of children safety netting information could be life-saving if a child with a serious illness is sent home.

“Parents often have a gut instinct and know when their child is seriously ill. When a child is ill and getting rapidly worse, parents should not be afraid to seek urgent medical help - even if they’ve already been seen by a doctor that same day.”

The report outlines that existing safety netting information is varied in the advice given and may not pick up both sepsis and meningitis. Furthermore it is not monitored or evaluated to ensure it is delivered to parents who need it.

An expert Meningococcal Working Group established in January 2018 at the request of Jeremy Hunt, then the Secretary of State for Health and Social Care, recommended that it should be recorded in a patient’s notes that safety netting information has been provided to patients with suspected infection if they are being sent home, and there should be mechanisms in place to monitor and audit that this is taking place.

To help take this forward, the new report by Meningitis Research Foundation recommends: a national audit of existing meningitis guidelines to ensure that safety netting information is being provided; standardising the many different national safety netting resources; and future monitoring by the Care Quality Commission to ensure safety netting advice is delivered to parents.

In the meantime, Meningitis Research Foundation has developed a resources hub on its website with currently available safety netting information for parents. Doctors can direct their patients to this or download and print documents to send a patient home with so that they know what to do if symptoms progress. 

GPs are often the first point of call for parents with a sick child. Studies show safety netting advice reduces re-attendances in children with less serious illness and can also reduce requests for inappropriate antibiotics. Therefore, providing safety-netting information helps free up GPs’ time and avoids multiple contacts being made for a relatively well child.