Which sign would most indicate increased intracranial pressure in a child with meningitis?

• A. Decreased appetite
• B. Sleepiness improves with stimulation
• C. Headache and vomiting
• D. Increased heart rate

Answer: (C)

Raised intracranial pressure in meningitis most commonly presents with a combination of headache and vomiting. The pressure from swelling and inflammation inside the skull irritates pain-sensitive structures and the vomiting center, producing these symptoms. In contrast, appetite change is nonspecific, and true raised ICP usually causes altered consciousness that does not improve with stimulation (somnolence or reduced responsiveness is more typical). Tachycardia can occur with fever or distress but isn’t a specific indicator of increased ICP. So the best sign here is the combination of headache with vomiting, which directly reflects the intracranial pressure rise.