Introduction: Bacterial meningitis involves inflammation of the meninges due to bacterial infection. Despite improved outcomes globally through immunization and intensive care, it remains a significant cause of morbidity and mortality in Indian children due to poor vaccine coverage, antibiotic resistance, and delayed treatment. Understanding its epidemiology and management is essential for better outcomes. Objectives: To study prevalence, clinical profile, lab profile and outcome in acute bacterial meningitis for children aged 1 month to <18 years. Method: A retrospective study (May 2019–May 2024) included children admitted with acute bacterial meningitis. Fifty-eight children were selected as per inclusion criteria. Data were collected in the form of history as well as clinical examination, laboratory data, radiological investigation, treatment, complications, and clinical outcome at discharge and post-meningitis sequalae at follow-up and analysed. Results: Fifty-eight paediatric cases of acute bacterial meningitis were studied; 53.5% children were >5 years, with a male: female ratio of 1.6:1. Common symptoms included fever (91.3%), altered sensorium (57.1%), and headache (46.6%). Cerebrospinal fluid (CSF) pleocytosis, hypoglycorrhachia, and elevated protein were seen in 57%, 34.5%, and 41.4% cases respectively. CSF culture positivity was 17.5%, with Streptococcus pneumoniae being the most common organism. Imaging abnormalities included meningeal enhancement and hydrocephalus. At discharge, 32.8% had sequelae. CSF neutrophil % significantly predicted sequelae (p=0.013), while C-reactive protein and erythrocyte sedimentation rate did not. Risk factors included concurrent infections (32.7%), sinusitis, pneumonia, congenital anomalies, and immunodeficiency. Conclusions: Streptococcus pneumoniae was the most common organism. At discharge, 32.8% had sequelae. CSF neutrophil % significantly predicted sequelae. Risk factors included concurrent infections, sinusitis, pneumonia, congenital anomalies, and immunodeficiency.