Children with neurological impairments are prone to develop serious infection due to anaerobic bacteria. They often are predisposed to develop infections caused by their own indigenous bacterial flora caused by impairments of their mechanical and immunological defenses, the change in their oral flora due to poor hygiene, and the delay in recognition of acute infection. The most common anaerobic infections are decubitus ulcers, gastrectomy site wound infections, pulmonary infections (aspiration pneumonia, lung abscesses, and tracheitis), and chronic suppurative otitis media. The unique microbiology of each of the infections and their medical and surgical management were discussed in this review.