A 2-month-old male has a fever of 103 degrees F and will not nurse. While his mother holds him his eyes are open and he is not moving. His vital signs are P 170 and R 38. You should suspect:

• A. Hypoglycemia
• B. Meningitis
• C. Head trauma
• D. Petit mal seizures

Answer: (B)

Fever with poor feeding and a markedly reduced level of responsiveness in a very young infant strongly suggests a serious CNS infection, such as meningitis. In infants this age, meningitis often presents nonspecifically with high fever, irritability or lethargy, and refusal to nurse or feed. The baby may appear awake but not move or respond normally, and a fast heart rate is common as the body responds to infection. Neck stiffness and classic seizure features are less reliable signs in this age group, which is why meningitis must be high on the differential despite the lack of typical “adult” symptoms. While other possibilities like hypoglycemia, head trauma, or absence seizures can cause altered behavior, the combination of high fever and acute decline in feeding and responsiveness makes meningitis the most likely and most dangerous diagnosis here. This scenario requires urgent evaluation and transport to a hospital for appropriate testing and treatment, since early antibiotics and management can be critical.