Mycoplasma pneumoniae (Mp)is a common cause of lower respiratory tract infection (LRTI) in children that is difficult to distinguish from LRTI of other etiologies. We aimed to determine if a combination of clinical, laboratory, and chest radiographic features can help identify patients at higher risk ofMpLRTI. We reviewed medical charts of children referred to our tertiary hospital with suspected acute mycoplasmal LRTI. Pharyngeal swabs obtained from patients were tested byMpPCR. We compared epidemiological and clinical data of children with positive and negativeMpPCR results. In addition, a multivariable logistic regression analysis was performed to predictMpLRTI based on the patient’s age, duration of symptoms, presence of extrapulmonary manifestations, laboratory findings, and chest radiographic findings. We included 65 children withMpPCR-negative and 49 withMpPCR-positive LRTI and no viral co-detection. Children withMpLRTI were older (median age 5.8 vs. 2.2 years,p< 0.001), had a longer duration of symptoms on referral (median 7 vs. 4 days,p< 0.001), and lower median WBC (9.9 vs. 12.7 × 109/L,p< 0.001). On chest radiograph, unilateral infiltrates were more frequently observed in theMpPCR-positive group (57.5% vs. 24.1%,p= 0.001). Age, duration of symptoms, and chest radiographic findings had the highest predictive value forMpLRTI in a multivariable logistic regression model. Our analysis suggests that a combination of clinical, laboratory, and chest radiographic features can be used to assess the likelihood ofMpLRTI and assist in decision-making for which children need further tests or macrolide antibiotic treatment.