Background <p>Pneumonia remains a leading cause of hospitalization and morbidity among children worldwide. While the pathogen spectrum and epidemiological patterns of pediatric pneumonia are known to vary by region and over time, there is a need for updated, comprehensive data to inform clinical management and public health strategies, particularly given the dynamic nature of respiratory pathogens and evolving diagnostic capabilities. This study aimed to analyze the contemporary pathogen spectrum and epidemiological characteristics of hospitalized children with pneumonia.</p> Methods <p>A total of 2,878 children with pneumonia were retrospectively analyzed. Seven common respiratory pathogens [<i>Mycoplasma pneumoniae</i> (MP), <i>Chlamydophila pneumoniae</i> (CP), <i>Legionella pneumophila</i> (LP), Respiratory syncytial virus (RSV), Influenza A virus (IFA), Influenza B virus (IFB), <i>Streptococcus pneumoniae</i> (SP)] were detected using nucleic acid testing, antibody assays, and culture. Differences in distribution across different genders, ages, and seasons were compared.</p> Results <p>The overall pathogen detection rate was 52.05% (1498/2878). MP was the dominant pathogen (42.39%), followed by IFB (17.23%) and IFA (11.71%). School-aged children had the highest positive rate (62.20%, 1790/2878). MP and IFB peaked in winter, whereas IFA was most common in spring. Mixed infections accounted for 18.49% of all cases, with combinations involving MP and influenza viruses being the most common.</p> Conclusions <p>The pathogen spectrum in pediatric pneumonia is primarily dominated by MP and influenza virus, with their distribution exhibiting marked variations according to age and season. Differentiated intervention strategies should be formulated in accordance with these epidemiological characteristics.</p>