Objective: To analyze the pathogen distribution and epidemiological characteristics of hospitalized children with acute lower respiratory tract infection (ALRT) in Suzhou. Methods: A retrospective analysis was performed on 0-18-year-old ALRT inpatients admitted between January 2022 and December 2024. Nasopharyngeal swabs were collected for respiratory pathogen detection. Results: Of 30,048 specimens, 80.37% tested positive for ≥1 respiratory pathogen. Mycoplasma pneumoniae (30.22%), human rhinovirus (25.05%), and human respiratory syncytial virus (13.44%) constituted the three most prevalent pathogens, with HRV+MP co-infection accounting for 28.4%.For age-specific distribution: HRSV prevailed in infants