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Objective: To determine clinical presentation of children below 5 years of age with acute respiratory tract infection Design & duration: This is across sectional study completed in six months of duration Setting: Study was conducted in Pediatric out-patient door of Bahawal Victoria Hospital Bahawalpur. Patients and methods: Children below five years of age presenting with acute respiratory tract infection in out-patient door of study hospital were included in this study. Consecutive sampling technique used. Inclusion and exclusion criteria applied in selection of patients. Patients having co-morbidities other than RTI, chronic respiratory disease, congenital disease, critically ill or mentally retarded were excluded from study. All data was documented on a Performa. Data was analyzed using SPSS software version 21. Results were calculated in the form of frequencies, percentages, means and standard deviation. Consent was taken from parents of children for including data of their children in the study. Permission was taken from ethical committee of the study hospital as well. Results: Total 380 cases were studied. Average age was 2.5±1.4 years. Mostly children were between 13-24 months of age. Most common presenting complaint was shortness of breath and cough in 38.4% and 24.5% cases. Majority of cases (75.3%) were treated by clinicians. Conclusion: Acute respiratory tract infection is most common disease among children below five years of age which usually present in the form of shortness of breath and cough. Self-treatment is not sufficient; hence doctor advice is required. Key words: Acute respiratory tract infection, shortness of breath, cough, pneumonia