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Totwatch / Meningitis

The Totwatch approach, including meningitis

Babies can become unwell very quickly, and it can be hard to know when a symptom is “just a cold” and when it is something more serious. The Totwatch approach is a simple set of warning signs to help parents recognise serious illness early and seek help fast.

This page covers the general Totwatch signs, plus specific guidance on meningitis, one of the most serious infections a baby can develop.

Warning signs to look out for

General signs

  • A high temperature above 38°C (or below 36°C in a baby under 3 months).
  • Unusual drowsiness, difficult to wake, or unusually floppy.
  • Refusing feeds, or feeding very poorly over more than one feed.
  • Inconsolable crying, or a high-pitched, weak or moaning cry.
  • Convulsions or seizures.
  • A rash that does not fade when you press a glass against it.
  • Your baby just doesn’t look right, and you can’t put your finger on why.

Breathing and circulation signs

  • Fast breathing, or noisy or grunting breathing.
  • Working hard to breathe: ribs visible with each breath, nostrils flaring, head bobbing.
  • Pale, mottled, blue or grey skin colour, including lips.
  • Cold hands and feet combined with a hot body.
  • A bulging fontanelle (the soft spot on top of the head feels firm and raised).
  • Less than half the usual number of wet nappies, or no wet nappy for 8 hours.

What is meningitis?

Meningitis is inflammation of the membranes that surround the brain and spinal cord. It can be caused by viruses (usually less severe) or by bacteria (more serious, and a medical emergency). Septicaemia is when a bacterial infection enters the bloodstream, and the two often occur together.

Meningitis is rare in newborns, and most children who develop it recover fully with prompt treatment. The key to outcome is speed of treatment.

Symptoms that may suggest meningitis in a baby include:

  • Fever
  • A bulging fontanelle (soft spot)
  • Refusing feeds or vomiting
  • Drowsiness, floppiness or being hard to wake
  • Irritability and high-pitched crying
  • Stiff body with jerky movements, or a floppy body
  • A rash that does not fade under a glass

If you suspect meningitis, do not wait for all the signs to develop. Go to the emergency department or call 112/999 straight away.

The glass test for the meningitis rash

1. Press Press the side of a clear glass tumbler firmly against the rash.

2. Look Look at the rash through the glass. A meningitis rash does not fade under the pressure of the glass.

3. Act If the rash does not fade, get medical help immediately. Do not wait to see if other symptoms develop.

Important: a rash is a late sign of meningitis. It does not appear in every case. Do not wait for a rash if other warning signs are present.

What to do if you are worried

  • Mild concern (some signs, baby is otherwise alert): Contact your GP or GP out-of-hours service for advice today.
  • Serious concern (multiple signs, baby unwell): Go to the emergency department or call 112/999.
  • Very ill baby, suspected meningitis, fits, blue or grey, or unresponsive: Call 112/999 immediately. Stay with your baby and start any first aid you know.

Trust your instincts. You will not be in trouble for going to the emergency department with a baby who turns out to be well. You will be glad you went in if your baby needs treatment.