Children get meningitis when a virus, bacterium, or (less commonly) fungus reaches the protective membranes surrounding the brain and spinal cord. The germ usually enters through the respiratory tract or bloodstream, though the specific route depends on the child’s age and the type of infection. Viral meningitis is far more common and typically mild, while bacterial meningitis is rarer but can become life-threatening within hours.
Viral Meningitis: The Most Common Type
The majority of meningitis cases in children are caused by a family of viruses called enteroviruses. These are extremely common in the general population and spread through several everyday routes: direct contact with an infected person (touching, shaking hands), touching contaminated surfaces and then touching the eyes, nose, or mouth, and the fecal-oral route, which is especially relevant in young children still in diapers.
Enteroviruses can be found in an infected person’s saliva, nasal mucus, blister fluid, and stool. In daycare and school settings, the virus moves easily between children who share toys, touch the same surfaces, or have close physical contact. Diaper changes are a particularly common transmission point for infants and toddlers. A caregiver who changes a diaper and doesn’t wash their hands thoroughly can spread the virus to other children or to their own mucous membranes.
Most children who catch an enterovirus get a mild illness or no symptoms at all. Only a small fraction develop meningitis. Other viruses that can cause meningitis in children include mumps, herpes simplex, and influenza, though these are less common causes.
How Bacterial Meningitis Spreads
Bacterial meningitis is less common but far more dangerous. The bacteria that cause it typically live harmlessly in the nose and throat of healthy people. They spread through respiratory and throat secretions, meaning saliva and spit. Kissing, sharing cups or utensils, and living in the same household are the kinds of close or prolonged contact that allow transmission. Importantly, these bacteria are not as contagious as cold or flu viruses. Casual contact like sitting in the same room generally isn’t enough.
Once the bacteria colonize a child’s throat, they don’t always cause disease. Many children carry meningitis-causing bacteria without ever getting sick. The problem arises when the bacteria enter the bloodstream and cross into the fluid surrounding the brain. Why this happens in some children and not others isn’t fully understood, but a weakened immune system, a recent viral infection, or being very young all increase the risk.
The Bacteria Differ by Age Group
The specific bacteria responsible for meningitis shift depending on a child’s age, which also changes how and where they’re exposed.
- Newborns (first month of life): Group B Streptococcus (GBS) is the leading cause of bacterial meningitis worldwide in this age group, affecting an estimated 390,000 infants each year. E. coli is the second most common culprit. These bacteria typically come from the mother during childbirth. GBS can live in a pregnant woman’s vagina or rectum without causing symptoms, and the baby picks up the bacteria while passing through the birth canal. If the mother’s water breaks more than 18 hours before delivery, the risk of GBS infection increases fourfold because bacteria can enter the womb. Babies can also acquire GBS from caregivers or hospital environments after birth.
- Babies and young children: Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) become the primary threats, along with Neisseria meningitidis (the meningococcal bacterium). These spread through respiratory droplets and close contact in homes and childcare settings.
- Teens and young adults: Meningococcal bacteria and pneumococcal bacteria are the main causes. Teens face elevated risk partly because of social behaviors like sharing drinks, kissing, and living in close quarters such as dormitories.
Infections That Spread to the Brain
Not all meningitis starts with a germ going directly to the brain. In some cases, an existing infection elsewhere in the body migrates there. Severe ear infections and sinus infections can occasionally lead to meningitis when bacteria penetrate through thin bone separating the sinuses or middle ear from the brain’s lining, or when they travel through nearby blood vessels. This can also happen when bacteria from a localized infection enter the bloodstream and then cross into the central nervous system. While this route is uncommon, it’s one reason doctors take persistent or severe ear and sinus infections in children seriously.
Why Young Children Are Most Vulnerable
Children under one year old have the highest rates of meningococcal disease of any age group, followed by a second peak during adolescence. Several factors explain why the youngest children face the greatest risk.
An infant’s immune system is still developing and less equipped to fight off invasive bacteria. Babies also can’t yet receive the full series of protective vaccines. The blood-brain barrier, which normally helps keep pathogens out of the central nervous system, is less mature in very young children. And infants in group childcare settings are in constant close contact with other children, sharing saliva-covered toys and surfaces in an environment where hygiene is difficult to maintain perfectly.
Meningococcal disease specifically has been rising. In 2024, 503 confirmed and probable cases were reported in the U.S., the highest number since 2013. Most serogroup B meningococcal disease occurs in young children.
How Vaccines Have Changed the Picture
Vaccination has dramatically reduced childhood bacterial meningitis over the past few decades. Three vaccines in the standard childhood schedule target the bacteria most likely to cause meningitis:
- Hib vaccine: Given in a series starting at 2 months, with doses through 15 months. Before this vaccine was available, Hib was the leading cause of bacterial meningitis in young children. It’s now rare.
- Pneumococcal conjugate vaccine (PCV): Also given in a four-dose series starting at 2 months. This protects against Streptococcus pneumoniae, one of the most common causes of bacterial meningitis in babies and young children.
- Meningococcal vaccine (MenACWY): Routinely given at age 11 to 12, with a booster at 16. Children with certain risk factors may receive it earlier. A separate vaccine targeting serogroup B meningococcal disease is available for teens and young adults.
Children who are behind on vaccinations or who haven’t yet reached the age for certain doses remain more vulnerable. This is part of why infants in the months before their vaccine series is complete face the highest risk.
Reducing Your Child’s Risk
Since most meningitis-causing germs spread through respiratory secretions or the fecal-oral route, basic hygiene is the first line of defense. Washing hands with soap and water for at least 20 seconds is especially important after diaper changes, using the bathroom, and coughing or sneezing. Regularly cleaning shared surfaces and toys helps reduce viral transmission in particular.
For newborns, GBS screening during pregnancy allows doctors to give antibiotics during labor to women who carry the bacteria, significantly lowering the chance of transmission. Keeping your child’s vaccinations on schedule is the single most effective way to prevent bacterial meningitis. Teaching older children and teens not to share drinks, utensils, or lip products also limits exposure to meningococcal bacteria.
Recognizing symptoms early matters too, because bacterial meningitis progresses fast. In older children, a sudden high fever, severe headache, stiff neck, and sensitivity to light are the hallmarks. In infants, the signs are less specific: irritability, poor feeding, a bulging soft spot on the head, and unusual sleepiness. These symptoms warrant immediate medical attention.