Which assessment finding in a child with a diagnosis of meningitis indicates an increase in intracranial pressure? Select all that apply.

A. Posturing is correct. Decorticate or decerebrate posturing indicates severe neurological compromise and is a late sign of increased ICP. Decorticate posturing (flexion of arms and extension of legs) suggests damage to the cerebral hemispheres, while decerebrate posturing (extension of arms and legs) indicates brainstem involvement, often associated with critically elevated ICP. Early recognition of subtle motor changes can help prevent progression to posturing. B. Irritability is correct. Early signs of increased ICP in children are often subtle, including behavioral changes such as irritability, inconsolable crying, restlessness, or lethargy. These signs occur before vital sign changes and are critical to detect early. C. Decreased pulse pressure is incorrect. Increased ICP usually produces a widened pulse pressure (elevated systolic minus diastolic pressure), not a decreased one. Narrow pulse pressure is not a typical early sign of ICP elevation. D. Decreased systolic blood pressure is incorrect. Hypotension is a late and ominous sign of ICP elevation, typically indicating brainstem failure or impending herniation. Initially, increased ICP causes hypertension as part of Cushing’s triad. E. Hyperactivity is incorrect. Hyperactivity is not associated with increased ICP. Children may initially show restlessness or irritability but generally progress toward lethargy, decreased responsiveness, or somnolence as pressure rises. F. Bradycardia is correct. Bradycardia is part of Cushing’s triad, which consists of hypertension with widening pulse pressure, bradycardia, and irregular respirations. This triad signals severe, life-threatening increases in ICP and potential brainstem compression, requiring immediate intervention.