BACKGROUND: Paediatric respiratory tract infections are one of the most common reasons for physician visits and hospitalization and are associated with significant morbidity and mortality. The World Health Organization (WHO) has suggested diagnosis and assessment of severity of ALRTI on the basis of clinical features and empirical antibiotics in all cases of ALRTI. This leads to administration of antibiotics to all children, including those with viral ALRTI. Concerns about unnecessary use of antibiotics for ALRTI have been expressed. objectivesTo study the clinical presentation and diagnosis of acute lower respiratory tract infections in outpatient and hospitalized patient Material and Methods The study was conducted in the Department of Pediatrics at Padmashree D Y Patil Hospital and Research Centre Kolhapur, Maharashtra. All the patients between 2 months to 5 years of age who attended the outpatient department with complaints of fever, cough, breathlessness, poor feeding with evidence of lower respiratory tract infection were included in the study. A detailed history was taken and a thorough physical examination performed. Three principal signs namely rapidity of breathing ,chest indrawing and inability to feed were assessed. From this disease is classified as mild , moderate, severe and this determines therapeutic intervention RESULTS During the study period there were 1043 patients admitted in the paediatric ward, out of which 207admissions were of LRTI (19.8%).In our study there were a total of 453patients suffering f rom LRTI. A total of 246 pat ients were treated on OPD basis and the rest of 207 (45.7%) needed hospitalization for their LRTI. There were 304 (67 %) male and 149 (33 %) female patients in our study.. Based on the age distribution among the OPD patients there were 157 patients in the age group of <1, 52 patients in the age group of 1–3, and 37 in the age group of 3–5years.Similarly, among the IPD patients there were 126, 68, and13 patients in the age group of <1, 1–3 and 3–5 respectively. Based on the clinical features in our pat ients for LRTI,we found that 308 patients presented with cough. The other most common signs and symptoms found in our study in thedecreasing order of frequency were: fever in 294, tachypnoea in 285 and chest indrawing in 267 of the patients. Stridor was found in 15 patients. Two hundred and thirty one patients presented wi th poor feeding and crepitatons were present in 144 patients. 350 patients were diagnosed as pneumonia, 68 had croup, 35 had bronchiolit is.Five patients presented with complications as empyema and pleural effusion. CONCLUSION:–Most of the ALRIs occurred in children below the age of 5 years (59.1%) than infants (40.9%).•It was observed that more male children suffered from acute respiratory tract infect ions than female children.•Clinically, majorityof the children had a respiratory rate more than 50/min. which formed a reliable clinical marker