Better training and management of hospital staff would cut the number of children dying from meningitis and related conditions, researchers say.
A meningitis rash does not fade when pressed
Meningococcal disease is the most common infectious cause of death in children in many developed countries.
Experts from the Meningitis Research Foundation analysed 400 UK cases.
Failures in management were significantly more common in cases where children died, the British Medical Journal study said.
Meningococcal disease progresses very quickly.
Many children with the condition are taken to their nearest A&E, but many die before they can be transferred to specialist units.
The Meningitis Research Foundation identified 143 children aged up to 16 who died from meningococcal disease in UK between December 1997 and February 1999.
For each child, three survivors of the same age and from the same area were also assessed - a total of 355 children.
A panel of paediatricians then looked at each case to see how quickly care had been given and what the quality of emergency was in the first 24 hours after the child was admitted.
It was found that failures in the management of meningococcal cases were significantly more common in the care of children who died than those who survived.
Not being treated by a paediatric team and junior doctors not being supervised by a consultant were significant risk factors.
The paediatricians said not giving adequate drugs to treat shock and organ damage, and failure to recognise complications in also increased the risk of death.
In the cases of children who died, their vital signs were often inadequately documented in nursing records.
Professor Michael Levin, Director of Research at Brighton and Sussex Medical School, who led the study said: "Our study provides clear evidence that the chance of surviving meningococcal septicaemia or meningitis, is reduced if children are treated by medical teams without involvement of a paediatrician, or without supervision by experienced consultants or if current treatment recommendations are not followed.
"The findings highlight the need for better consultant supervision, and improved training of medical teams involved in the care of critically ill children."
Denise Vaughan, Chief Executive of Meningitis Research Foundation, said: "Although the discovery of failures in the delivery of healthcare to children is distressing to families and healthcare professionals alike, progress in treatment can only be made by identifying where failures occur and correcting them."
The MRF has put together a handbook to help junior doctors identify the signs of meningococcal disease, which also details the kind of mistakes which have been seen in the study so they medics know what to watch out for.
Ms Vaughan said: "We hope that these measures will save lives"