The red flag symptoms indicating suspected meningitis in children include: fever, headache, neck stiffness, and altered level of consciousness or cognition (including confusion or delirium) NICE NG240.
In babies, a bulging fontanelle and non-blanching petechial or purpuric rash, especially if rapidly spreading or larger than 2 mm, are red flags NICE NG240.
Other signs include ill appearance, pale, mottled skin or cyanosis, irritability, lethargy, reduced feeding, and unusual behaviour such as agitation, aggression, or subdued behaviour NICE NG240.
Additional signs are a weak, high-pitched, or continuous cry in babies, and in older children, symptoms like vomiting, high age-specific heart rate, low blood pressure, and signs of sepsis such as cold hands and feet or capillary refill time ≥3 seconds NICE NG240.
Any of these symptoms, especially when combined with a non-blanching petechial or purpuric rash, should prompt urgent hospital transfer NICE NG240.