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Aim Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections in children and the development of vaccines to protect at‐risk groups is a global priority. The aim of this study was to describe RSV subtype circulation patterns and associated disease severity to inform on potential impact of an RSV‐specific prevention strategy. Methods Single‐centre retrospective observational study of children aged <16 years with laboratory‐confirmed RSV infection from 2014 to 2018 inclusive. We described the features and frequency of all RSV subtype detections. We selected a random sample of RSV‐A and RSV‐B cases from each year (n = 200), described demographic and clinical features of these cases, and compared indicators of disease severity between subtypes. Results We identified 3591 RSV detections over a 5‐year period and found consistent co‐circulation of subtypes with alternating predominance. Demographic and clinical characteristics were similar between children presenting with RSV‐A and RSV‐B infections. There was no difference in indicators of severity between the subtypes except for paediatric intensive care unit length of stay which was longer in the RSV‐B group (3 vs. 5 days, P = 0.006). Respiratory co‐infections were more frequent in the RSV‐B group (41.8% vs. 27.4%, P = 0.035). When these were excluded there was no longer a detectable difference in paediatric intensive care unit length of stay. Conclusions We found co‐circulation of RSV subtypes and no convincing evidence of a difference in disease severity between subtypes. RSV‐specific interventions will need to be equally effective against both RSV‐A and RSV‐B to have the greatest impact on reducing severe RSV disease in this population.

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