Meningitis and Febrile Seizures in Children

Pediatrics · Neurology (Seizures, Meningitis)·Updated 2026-10-28

What it is

Bacterial meningitis is infection of the meninges, most often from Streptococcus pneumoniae or Neisseria meningitidis after infancy and from group B streptococcus or Escherichia coli in newborns. The inflammatory exudate raises intracranial pressure (ICP) and can damage the auditory nerve, so care centers on early antibiotics, ICP and seizure monitoring, and hearing follow-up. A febrile seizure is a seizure with a fever of 100.4 F (38 C) or higher in a child 6 to 60 months old without a CNS infection; the immature brain has a lower seizure threshold during fever.

What the NCLEX focuses on

Older children: fever, headache, vomiting, photophobia, nuchal rigidity, and positive Kernig and Brudzinski signs.
Infants: bulging fontanel, poor feeding, irritability, a high-pitched cry and lethargy; nuchal rigidity is often absent.
A petechial or purpuric rash suggests meningococcemia, which progresses rapidly to shock and DIC.
CSF in bacterial meningitis: cloudy, high white cell count (neutrophils), high protein, low glucose; in viral meningitis: clear, lymphocytes, normal glucose.
During a lumbar puncture in an infant, avoid extreme neck flexion and watch respirations and SpO2.
Simple febrile seizure: generalized, less than 15 minutes, once in 24 hours; complex: focal, 15 minutes or longer, or repeated within 24 hours.
Simple febrile seizures need no daily antiseizure drug, routine EEG or neuroimaging; antipyretics improve comfort but do not prevent recurrence.

Priority nursing actions

Place the child on droplet precautions as soon as bacterial meningitis is suspected.
Maintain the airway and seizure precautions; during any seizure, turn the child to the side, time it and put nothing in the mouth.
Obtain blood cultures, assist with the lumbar puncture and give prescribed IV antibiotics without delay.
Monitor level of consciousness, vital signs, pupils, fontanel and head circumference for rising ICP.
Keep the room quiet and dim, raise the head of the bed 30 degrees, and track intake, output, daily weight and serum sodium for SIADH.

Numbers to know

Value	Threshold or normal	Why it matters
Fever	100.4 F (38 C) or higher	Required for a febrile seizure
Febrile seizure age	6 to 60 months	Outside this range, look for another cause
Simple febrile seizure	Generalized, under 15 minutes, once in 24 hours	Longer, focal or repeated seizures are complex
Recurrence after a first febrile seizure	About 1 in 3 children	Most recurrences happen within the first year
Seizure duration for rescue medication or 911	5 minutes	Status epilepticus risk
Droplet precautions (N. meningitidis, Hib)	Until 24 hours of effective antibiotics	Prevents spread to staff and family

Common exam traps

Choosing to wait for nuchal rigidity before suspecting meningitis in a young infant: wrong because infants show a bulging fontanel, poor feeding and a high-pitched cry instead.
Choosing to delay precautions until CSF results return: wrong because droplet spread occurs before the diagnosis is confirmed.
Choosing round-the-clock antipyretics to prevent another febrile seizure: wrong because they do not lower recurrence.
Choosing a cool or alcohol sponge bath: wrong because shivering raises body temperature and alcohol is absorbed through the skin.
Choosing to skip the hearing evaluation because the child responds to voices: wrong because meningitis is a leading cause of acquired sensorineural hearing loss and partial loss goes unnoticed at home.

What to teach

If a febrile seizure recurs, lay the child on the side on a flat surface, time it, put nothing in the mouth and call 911 if it lasts 5 minutes or breathing is difficult.
Simple febrile seizures do not cause brain damage or learning problems, and daily medication is not needed.
Dress the child lightly and give acetaminophen or ibuprofen for comfort; never give aspirin.
After meningitis, keep hearing and developmental follow-up and vaccines on schedule; close contacts of meningococcal disease receive prophylactic antibiotics.

Client handout: Fever in Children: What to Do (nurse guide and printable patient handout).

Try 2 NCLEX-style questions on this topic

From the NCLEXPace question bank. Pick your answers, then check them inside NCLEXPace.

Question 1 · QID F61D227E

The nurse teaches the parents of a 15-month-old who had a first simple febrile seizure. Which statements should the nurse include? Select all that apply.

A. "These seizures usually cause learning problems later in school."
B. "Giving ibuprofen around the clock will prevent another seizure."
C. "Time the seizure and call 911 if it reaches 5 minutes, or sooner if breathing is difficult."
D. "About 1 in 3 children have another febrile seizure, often within the next year or two."
E. "She will need a daily antiseizure medication from now on."
F. "Put your child on her side on a flat, clear surface if it happens again."

Question 2 · QID 1001B4AA

A 15-month-old is being discharged after completing 10 days of intravenous antibiotics for pneumococcal meningitis. For each parent statement, indicate whether it is correct or requires further teaching.

For each statement, identify whether it is correct or requires further teaching.

	Correct	Requires further teaching
"Learning or behavior problems might not appear until she is in school."
"Since the antibiotics worked, her hearing cannot be damaged."
"She needs a hearing evaluation now and again in a few months."
"If she seems to hear us at home, we can skip the audiology visit."
"She should still receive her scheduled vaccines on time."

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More tips on Pediatrics

Type 1 Diabetes in Children: Lows, Sick Days and DKATreat hypoglycemia in children safely, keep basal insulin on sick days, spot cerebral edema in DKA, and match self-care to the child's age.Immunizations: Schedule Principles and ContraindicationsKnow which vaccines are live, the true contraindications versus the false ones, the timing rules, and safe administration and teaching.Growth and Development MilestonesLearn the motor, language and social milestones the NCLEX tests, the red flags that need referral, and the type of play expected at each age.

Sources

Hockenberry MJ, Duffy EA, Gibbs KD. Wong's Nursing Care of Infants and Children. 12th ed. Elsevier; 2024.
Subcommittee on Febrile Seizures; American Academy of Pediatrics. Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure. Pediatrics. 2011;127(2):389-394.
Steering Committee on Quality Improvement and Management, Subcommittee on Febrile Seizures; American Academy of Pediatrics. Febrile Seizures: Clinical Practice Guideline for the Long-term Management of the Child With Simple Febrile Seizures. Pediatrics. 2008;121(6):1281-1286.
Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention; 2007.

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