More guidance is required in the management of acutely ill, febrile young infants. Of 94 young infants undergoing lumbar puncture (LP) as part of their management, 26 of the 60 (43.3%) presenting with seizures and fever and six of the 34 (17.7%) without seizures had bacterial meningitis (BM) (relative risk (95% confidence interval) = 2.46 (1.12, 5.37), p = 0.012). Except for the presence of a bulging fontanelle and focal seizures, no other presenting signs or symptoms were significantly associated with BM; seven of the 26 infants with BM who presented with seizures and two of the six without seizures lacked a bulging fontanelle. Overall, the ratio of BM to other illnesses was 1:1.94; of those with BM, 13 of the 32 (40.6%) had co-existing acute respiratory infections and four of the 32 (12.5%) had asexual malaria parasitaemia. Seizures with fever are an important presenting feature of BM in young infants and a screening LP should be considered mandatory to confirm or exclude BM in febrile young infants with seizures, unless certain contraindications apply.