<p>Purulent meningitis is a common disease of the central nervous system affecting children. It arises from various pathogens transmitted through diverse routes and can lead to significant sequelae, even death. The pathogenesis involves varying degrees of meningeal damage by pathogens, breaching the blood-brain barrier (BBB) and triggering immune responses and other physiological processes. Early diagnosis of purulent meningitis relies on recognizing clinical symptoms and conducting comprehensive examinations in patients. This includes young children presenting with systemic symptoms of infectious toxemia, neurological abnormalities, C-reactive protein (CRP), and procalcitonin (PCT) levels. Additionally, examination of cerebrospinal fluid (CSF) for abnormalities, identification of bacterial pathogens at the genetic level, brain computed tomography (CT) and magnetic resonance imaging (MRI) findings are crucial. Culturing bacteria from CSF remains the gold standard for diagnosing purulent meningitis. Current treatment approaches primarily involve antibacterial drugs, supportive therapy, and immunotherapy. Promising advancements are being made in exploring further treatment options and strategies. It is noteworthy that poor prognosis in pediatric patients can be inferred from clinical manifestations, laboratory findings, and imaging results. This review expounds on the recent progress in understanding the pathogenesis, early recognition, treatment strategies, and risk factors associated with poor outcomes in purulent meningitis affecting children (See Graphical Abstract).</p> Graphical Abstract <p></p>