June 11, 2019

Diagnosis of meningitis in children – why practitioners need to listen to parental concern

The charity Meningitis Now aims for a future “where no one in the UK loses their life to meningitis”. One of their methods of doing this is to raise greater awareness of the signs and symptoms of this terrible disease so that people can hopefully seek medical help early enough to get treatment. However, where help is sought by parents – do medics properly listen to parental concerns, take on board and interpret what they are told and respect valid fears?

When six year old Oliver Hall became ill his mother dialled 999 seeking emergency assistance. The inquest heard Mrs Hall’s description of the paramedic who attended having rolled his eyes at her concerns and mimicked her son’s grunting noises, suggesting that he was going to “milk it”. Even once admitted to hospital his condition was still not diagnosed; Oliver’s father told the inquest: “We were made to feel we were over-sensitive parents who did not know what we were talking about.”

The inquest heard from Professor Nigel Klein, a professor of infectious diseases, who advised the court that with earlier treatment he believed Oliver would have survived.

This inquest had highlighted the role of parental concern and the need for medics to listen to parents when they state they feel there is something seriously wrong with their child.

What the experts are saying

A recent study has been published (1) looking into this issue in relation to sepsis, which sought to better understand how to improve outcomes:

Sepsis is a time critical disease and outcomes strongly depend on time to initiation of appropriate treatment in hospital….The decision-making of parents in seeking medical care may substantially impact survival of children with sepsis. An improved understanding of the parental perspective in recognizing sepsis is urgently needed to inform the design of education campaigns and consideration of using parental concerns as a trigger in sepsis screening tools.

The study notes that there is a paucity of research and data into the role of parental concerns in assisting medics to come to a swift diagnosis, and further work is urgently needed in this field.

The study noted:

Several guidelines and institutional protocols emphasize the importance of listening to parents and utilize parental concerns as one of the trigger criteria for sepsis recognition. Parental concern needs to be considered to improve accuracy in recognizing life threatening infections in children…..understanding parental perceptions of sepsis, and parental decision-making in seeking advice is urgently needed.

Tragically there are far too many reported claims related to a failure to diagnose meningitis (either bacterial or viral), and related sepsis, in a timely manner. A critical risk area relates to telephone consultations with GPs or non-medically trained NHS “111” call handlers, who can easily misinterpret or dismiss a parents description of a rash as being non- typical for meningitis because the parent may not use words with relate to a classic purple/red “rash”, but instead may refer to spots or blotches on the skin. In addition, where a child’s temperature has risen and then dropped following administration of paracetamol or ibuprofen, this may be falsely taken as a reassurance that this couldn’t be a septic infection.

This has been a long-standing point of discussion and in an article in the Daily Mail from 2012 it was noted by Meningitis UK that in half of all cases children had been sent home after being told there was ‘nothing serious’ going on, and urged parents to ‘trust their instincts’.

Furthermore, clinicians stressed the point that subtle changes in the way a child cries may only be noticed by a parent and so keeping an eye out for an ‘unusually distressed mother’ is of vital importance in preventing cases of meningitis from becoming more serious. After all, given children’s physiology, acute illnesses can become dangerous much quicker than in adults.

The basic premise of ‘fail to listen to a parental concern at your peril’ is a good one. It is very much hoped that future research will assist to reduce infant deaths from this terrible disease.

  1. The Role of Parental Concerns in the Recognition of Sepsis in Children: A Literature Review: Harley A, Latour JM and Schlapbach LJ (2019) Front. Pediatr. 7:161. Doi 10.3389/fped.2019.00161


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