The ‘Behind the Headlines’ service from NHS Choices has featured a quality assessment of press reports that doctors should check ill children for leg pain, confusion, stiff neck and sensitivity to light, as they are ‘red flag’ symptoms for meningitis.

The assessment notes that the stories are based on a non-comparative study looking at the frequency of certain classic and ‘red flag’ symptoms associated with meningococcal disease.  The researchers found that headache and paleness, which are often suggested as possible early warnings signs, were just as frequent in children who had minor infections. However, confusion, sensitivity to light, neck pain/stiffness and leg pain (the four ‘classic’ symptoms) were all stronger indicators of meningococcal disease. Although the development of a rash is an important sign, it typically appears at a later stage of infection.

The authors note that this study confirms that the four classic symptoms of meningococcal disease are very rare in children with minor febrile illness.  However it also found that two symptoms often described as early warning signs – pale skin and headache – are equally likely to indicate a minor illness. Cold hands and feet were only slightly more likely in children with meningococcal disease. 

The authors of the assessment discuss the limitations of the study, which mean that the results need verification.