Objective It was aimed to analyze the clinical characteristics of the children with initially-diagnosed tuberculous meningitis (TBM) and their prognostic risk factors. Methods The clinical data of hospitalized children with initially-diagnosed tuberculous meningitis (including tuberculous meningoencephalitis) between June 2011 and June 2019 were retrospectively analyzed. Results A total of 94 children were included，including 80 cases of TBM (85.1%) and 14 cases of tuberculous meningoencephalitis (14.9%). Among the children，there were 1 confirmed case (1.1%)，76 probable cases (80.8%)，and 17 possible cases (18.1%). Regarding of TBM staging，there were 28 (29.8%)，32 (340%) and 34 (36.2%) cases at stage Ⅰ，Ⅱ and Ⅲ，respectively. According to Pediatric Cerebral Performance Category(PCPC)，there were 59 cases (62.8%) with a favourable prognosis (PCPC score≤3) and 35 cases (37.2%) with a poor prognosis (PCPC score>3). In addition，6 out of 94 cases (6.4%) died finally and all of them were at stage Ⅲ of TBM. Univariate analysis showed that convulsions，altered consciousness，impaired peripheral nerve function，positive signs of meningial irritation，positive Babinski′s sign，damaged cranial nerves，decreased glucose level in cerebrospinal fluid (CSF)，hydrocephalus，extracranial tuberculosis，low GCS score and advanced stage of TBM at admission were all associated with the poor prognosis of the cases (P＜0.05). Multivariate analysis showed that stage Ⅲ of TBM (OR=22948，95%CI 1.880～280.113) was an independent risk factor for prognosis of the cases. Conclusion A big proportion of TBM patients has presented with a poor prognosis. The use of new testing techniques and active cerebrospinal fluid examinations for patients with extracranial tuberculosis can help early diagnosis. Active empirical anti-tuberculosis treatment for children who were suspected of being diagnosed with TBM and whose disease was progressing quickly can help early treatment. Stage Ⅲ of TBM was a risk factor for prognosis of the cases. Early diagnosis and treatment would be beneficial for improving the prognosis of TBM.