Objective <p>This study aimed to investigate the prevalence of human coronavirus (HCoV) infection among pediatric patients with acute respiratory tract infection (ARTI) and to analyze the associated clinical features.</p> Methods <p>A total of 15,281 pediatric patients diagnosed with ARTI admitted to Xiamen Children’s Hospital between January 2022 and June 2024 were included in this study. Clinical symptoms and signs in HCoV-positive patients were analyzed and compared with those of patients with respiratory syncytial virus (RSV) infection during the same period.</p> Results <p>HCoV was detected in 147 of 15,281 patients, corresponding to a detection rate of 0.93%. Annual detection rates were 0.87% (54/6,230) in 2022, 0.82% (53/6,439) in 2023, and 1.53% (40/2,612) in 2024. Detection rates were highest in autumn and winter, peaking in November (1.89%). Of the 147 cases, 80 involved HCoV mono-infection, while 67 were co-infected with other respiratory viruses. The most common HCoV-associated clinical manifestations were cough, fever, and wheezing. The incidence of wheezing was higher in the RSV group compared to the HCoV group (<i>p</i> &lt; 0.05). No statistically significant differences were observed between the two groups regarding other symptoms, complications, or the proportion of cases requiring mechanical ventilation (<i>p</i> &gt; 0.05).</p> Conclusions <p>The HCoV detection rate among pediatric patients with ARTI in Xiamen between January 2022 and June 2024 was 0.96%. The clinical manifestations and severity of HCoV-associated ARTI were comparable to those of RSV infection.</p>