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Practice BMJ Best Practice

Bacterial meningitis in children

BMJ 2023; 381 doi: (Published 24 May 2023) Cite this as: BMJ 2023;381:p728
  1. Emre Basatemur, consultant in paediatric emergency medicine
  1. The Royal London Hospital, London, UK
  1. Correspondence to E Basatemur emre.basatemur{at}

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What you need to know

  • Classic signs of meningitis (neck stiffness, bulging fontanelle, high pitched cry) are often absent in infants with bacterial meningitis

  • Around half of young infants diagnosed with bacterial meningitis are afebrile on presentation

  • Escalate early. Consult a senior doctor in emergency medicine or paediatrics if you suspect bacterial meningitis

Bacterial meningitis is a life threatening inflammation of the meninges, which most commonly affects children under 2 (especially those under 3 months). It is a notifiable disease in the UK.

This article, based on BMJ Best Practice, covers assessment of and initial management of suspected bacterial meningitis acquired by children in the community; the condition may also be associated with invasive procedures or head trauma, but meningitis associated with healthcare, and infants with meningitis in neonatal units, are beyond the scope of the article.


A 2018 study reported the overall incidence of bacterial meningitis in western countries as 0.7 to 0.9 per 100 000 people per year. Incidence has decreased by 3% to 4% since the 1990s.1 In the UK, 2594 cases of meningitis (due to any cause) were reported in children from 2004 to 2011. The overall incidence in African countries is 10-40 per 100 000 people per year.1 The incidence of culture-proven bacterial meningitis in newborns is estimated at 0.3 per 1000 live births in developed countries.2

Widespread immunisation programmes in the UK and other developed countries, particularly the use of Haemophilus influenzae type b (Hib) …

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