Introduction: Lower respiratory tract infections (LRTI) are one of the leading causes of morbidity and mortality among children worldwide. Objectives: This study aims to describe the patterns in clinical presentation, laboratory and radiological characteristics of LRTIs and ascertain their association with disease progression and response to treatment. Method: A descriptive prospective study was conducted on children aged 1 month to 14 years admitted to Paediatric wards in Colombo North Teaching Hospital Ragama, from 1 March 2025 to 31 December 2025 fulfilling clinical criteria for diagnosis of LRTI. Demographic and clinical details were collected using a data collection sheet. Results: A total of 88 children (male: 49%, mean age: 5.7-3.4 years) were recruited. The mean duration of symptoms at presentation was 4.8-2.7 days and most common symptoms were cough (100%), rhinorrhea (87%), fever (80%) and difficulty in breathing (49%). Features of respiratory distress, tachypnoea and chest wall recessions were present in 72% and 65% respectively . CRP was elevated in 87% and chest x-ray showed non-alveolar (44%) or alveolar pneumonia (27%) in majority . Poor response to initial antibiotic therapy within 48 hours was significantly associated with age >5 years (p=0.03); duration of symptoms >5 days on admission (p=0.01); presence of clinical features like chills and rigors, poor appetite, tachycardia, tachypnoea, chest wall recessions, reduced air entry (p