A nurse is collecting data from a 4-month-old infant who has meningitis. Which of the following manifestations should the nurse expect?

Meningitis in a 4-month-old infant produces signs that differ from those seen in older children and adults because of the immature nervous system and open fontanels. A high-pitched, inconsolable cry is a classic hallmark of meningeal irritation in infants and reflects neurological distress; it is one of the most consistently noted findings in infant meningitis and should prompt immediate evaluation. Constipation is not associated with meningitis; vomiting and diarrhea are far more common accompanying gastrointestinal symptoms. The rooting reflex is a normal primitive reflex present in neonates and young infants up to approximately 3–4 months and is not a sign of meningitis; its presence is therefore expected at this age regardless of the diagnosis and does not indicate pathology. A depressed anterior fontanel would suggest dehydration, not meningitis; meningitis causes increased intracranial pressure, which produces a bulging or tense anterior fontanel, not a depressed one. Other signs the nurse should watch for in infant meningitis include a bulging fontanel, fever or hypothermia, poor feeding, lethargy or irritability, and a petechial or purpuric rash if the cause is bacterial. Recognizing the high-pitched cry as the key expected manifestation is critical for early identification and treatment.