Meningitis, the disease most feared by parents because of its rapid onset and swift and sometimes fatal progress, could be spotted earlier, say researchers who have identified new symptoms.

Most parents know that a red rash which does not disappear when a glass is pressed on to the skin and a stiff neck are danger signals for meningitis. But scientists have now identified earlier warning signs, such as leg pain, cold hands and feet, and abnormal skin colour. In a paper published online today by the Lancet medical journal, they call for parents and doctors to be told about them.

Matthew Thompson from the department of primary healthcare at Oxford University and colleagues say the classic symptoms - rash, headache, stiff neck, sensitivity to light and impaired consciousness - develop late in the progress of the disease, at 13 to 22 hours. By the time those signals are spotted, the child needs to be in hospital.

But by studying the medical records of 448 children with meningococcal disease and questioning their parents, the researchers found that 72% of them had shown signs of blood poisoning within eight hours. These early symptoms were leg pain, cold hands and feet, and abnormal skin colour.

Doctors and parents wait too long, they say, looking for rashes and impaired consciousness. "We believe that primary care clinicians are over-reliant on using these ... symptoms to diagnose meningococcal disease in children and that parents may be influenced by doctors or public health campaigns to seek medical advice only on the appearance of features such as a rapidly evolving rash," they write. "Moreover, clinicians and parents may be falsely reassured by the absence of these features."

There are earlier symptoms still, but they are common to other diseases. Within the first four to six hours, children experience fever, loss of appetite, nausea, vomiting and are irritable.

This does not mean that every child with a sore throat should be taken to the GP for fear of meningitis, but it does mean that doctors cannot rule out meningitis in such children.

The disease progresses rapidly, so parents must be encouraged to go back to the doctor if the child gets worse. If the GP is at all concerned, he or she should arrange to see the child again within four to six hours - not the next day.

The authors believe that there should be a "paradigm shift" in diagnosis to include the earlier symptoms.

Leg pain, cold hands and feet, and abnormal skin colour are rarely reported by parents to the doctor, so they are valuable warning signs: "We believe that there would be little risk of harm and considerable benefit if these symptoms were to be promoted to both parents and doctors as warnings of potential meningococcal disease."