Aim . The aim of this study was to describe the disease severity and clinical course and outcome of hospitalised HIV-infected children aged <6 months. Methods . A retrospective case review was completed at Red Cross Children’s Hospital (RCCH) during the middle of 2006. Perinatal management, disease severity and hospital outcomes were analysed. In a sub-analysis, the disease profile and outcome of admitted children aged less than and more than 6 months were compared over the latter 3 months of the study. Results . Seventy-five out of 121 (43.86%) of all HIVinfected children admitted over the study period were <6 months of age. Sixty-nine out of 72 (95.83%) of the children not receiving highly active antiretroviral therapy (HAART) at admission, qualified according to current WHO treatment criteria. The most frequent cause for admission was pneumonia (54.67%). The inpatient fatality rate was 28%, pneumonia being the most frequent cause of death (61.9%). Fifty-two out of 75 (69.33%) of the mothers reported having been tested for HIV during pregnancy. Thirty-four out of 37 (91.89%) who tested HIV-positive during pregnancy received prevention of mother-tochild transmission (PMTCT) prophylaxis. Children with confirmed/presumed Pneumocystis jiroveci pneumonia (PJP) were less likely to have mothers who received PMTCT prophylaxis (18.51% v. 61.7%, p=0.0004), and less likely to be receiving cotrimoxazole prophylaxis (14.81% v. 46.81%, p=0.006) at admission. Children >6 months were more likely to be receiving cotrimoxazole prophylaxis (65.4% v. 31.1%, p=0.0008) and HAART (42.3% v. 6.7%, p=0.00007) at the time of admission. Of those not on HAART, 27 out of 30 (90%) had WHO stage 3 or 4 disease. Inpatient fatality in this group was 13.5%. Conclusions . Young children constitute a sizeable proportion of the inpatient paediatric HIV workload. Comprehensive PMTCT interventions and earlier introduction of HAART may reduce morbidity, hospitalisation rates and mortality.