OBJECTIVES: To investigate the epidemiological profile and cost burden of pediatric inpatients with tuberculous meningitis (TBM) in China. METHODS: We conducted a descriptive multicenter study involving pediatric TBM inpatients from 9 provincial hospitals and 20 municipal hospitals across 24 provinces in China from January 2016 to December 2021. Sociodemographic and geographic variables, admission and discharge information were extracted from face sheets of discharge medical records to describe the epidemiological characteristics. Length of hospital stay (LOS) and hospitalization expenses were used to assess disease burden. RESULTS: TBM accounted for 0.01% (971/7,647,598) of total hospitalization cases and 15.82% (971/6,138) of TB cases. The proportion of TBM children aged 1-3 (39.13%, 380/971) years were the highest. TBM children aged <
1 year had longest LOS (12d) and highest total costs (447.55). Minority patients had a higher proportion of TBM hospitalizations (24.09% vs 13.79%), longer LOS (11d) and higher diagnostic costs (45.95 vs 28.47) than Han people. The northwest region had the highest rate of TBM hospitalization (n = 272, 28.01%) and the longest LOS (8d). TBM + PTB group exhibited the highest rate of outpatient admission (78.51%,263/335), shortest LOS (5d) and lowest total cost (729.75) and diagnostic cost (27.30). The most prevalent concomitant TB infection site was the lung (n = 494, 50.82%). TBM + PTB + other EPTB group had the longest LOS (14d) and highest total cost (380.54). CONCLUSION: Pediatric TBM poses substantial disease burden in China, especially in western regions and children under six years old. Early diagnosis and treatment for children with TBM should be suggested.