Background To determine the frequency of acute meningitis (bacterial + viral/aseptic) among children (06 – 60 months old) with ‘1st episode of febrile seizures at a tertiary care hospital and the utility of lumbar puncture as a diagnostic tool in such patients’ Methods A retrospective cross-sectional study was conducted at Department of Pediatrics, Medicine, Northwest General Hospital and Research Centre, Peshawar’. From January 2021 to July 2023. A total number of 145 children who presented with 1st episode of febrile seizures, aged 06 – 60 months, were included in this study. Data regarding age, gender, residential area, family history of seizures/febrile seizures, vaccination status of patients, type (simple/complex) of seizure, meningeal signs, and lumbar puncture status were taken for each child. ‘Cerebrospinal fluid Dr. Mohammad Arif/Afr.J.Bio.Sc.6(15) (2024) Page 15450 (CSF) was analyzed to determine the frequency of meningitis among children presenting with fever and a first attack of seizure’. Results The Mean age of children was 20.04 months ± 16.278, and the median of 12 months. There were 101 (69.70%) male children and 44 (30.30%) ‘female children’. ‘There were 53 (36.6%) children having a positive family history of seizures/febrile seizures. 103 (71%) children were from urban areas, and the rest were from rural areas’. Meningitis was found in 73 (50.30%) children, among them 39 (26.9%) were found to be acute bacterial, while 34 (23.4%) were of acute viral meningitis cases. Conclusion The occurrence of meningitis among children presenting with febrile seizures was found to be considerably high in this study. Acute bacterial meningitis was diagnosed in 26.9% of children experiencing their first episode of febrile seizure. Based on these findings, lumbar puncture is strongly advised for children aged 6 to 12 months, as this age group demonstrated a higher incidence of meningitis. Similarly, children who are partially vaccinated or unvaccinated should also undergo lumbar puncture when presenting with febrile seizures, given their increased susceptibility to central nervous system infections.