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Abstract Objective Mycoplasma pneumoniae is a major causative pathogen in community-acquired pneumonia. Respiratory viral coinfections in children with Mycoplasma pneumoniae pneumonia (MPP) are not uncommon and cause severe clinical manifestations. This study aims to investigate the impacts of viral coinfection in MPP patients and hopes to offer novel insights for discriminating between MPP and MPP coinfection. Methods This study recruited 748 children hospitalized for MP pneumonia between January 2021 and October 2023. Patients were classified into two groups: MPP coinfected with respiratory virus group and MPP group. All children underwent polymerase chain reaction testing for respiratory pathogens. Baseline clinical features and demographic data were obtained retrospectively through medical records. Results The retrospective study included 748 patients, with a viral coinfection rate of 38.75%. Patients in the MPP coinfected with respiratory virus group have a higher disease burden than those in the non-coinfection group. Our findings indicate that patients with Mycoplasma pneumonia co-infected with respiratory viruses had longer hospital stays and prolonged fever post-admission, as well as more severe conditions and a higher incidence of extrapulmonary complications. MPP coinfection was associated with the following factors: patients with extrapulmonary complications of gastroenteritis (OR = 4.474, 95%CI = 1.733–11.554, P = 0.002), longer hospital stay (OR = 1.109, 95%CI = 1.012–1.217, P = 0.027), longer days of fever after admission (OR = 1.215 95%CI = 1.006–1.469, P = 0.043), elevated white blood cell count (OR = 1.332 95%CI = 1.082–1.640, P = 0.007), decreased neutrophil count (OR = 0.768 95%CI = 0.602–0.981, P = 0.035), higher fibrinogen levels (OR = 1.652 95%CI = 1.138–2.398, P = 0.008), and raised lactate dehydrogenase levels (OR = 1.007 95%CI = 1.003–1.011, P = 0.001). Conclusions We determined the clinical significance of respiratory viral coinfection in children with MPP. Timely identification of MPP coinfection and provision of early and comprehensive therapeutic measures are vital in shortening the disease severity and improving prognosis.