BackgroundThe incidence of coronavirus disease 2019 (COVID‐19) in children has been increasing worldwide since the onset of the pandemic. This study examined the risk factors and characteristics of COVID‐19 among pediatric patients compared to other respiratory viral infections.MethodsThis was a prospective cross‐sectional study. Patients aged 0–18 years presenting with respiratory symptoms from October 2020 to December 2021 were included. Demographic and clinical data were reviewed.ResultsIn total, 738 pediatric patients were enrolled. Of these, 48.5% had COVID‐19, and 41.3% were infected with another respiratory virus. The COVID‐19 incidence increased from 0.5% during the original strain outbreak (October 2020 to March 2021) to 56.5% and 73.4% during the alpha (April to June 2021) and delta (July to December 2021) periods, respectively. Children aged 6‐18 years, being female, obesity, exposure to household members with COVID‐19, and the delta period were risk factors for COVID‐19. Being aged 1‐5 years, obesity, shortness of breath, productive cough, and chest pain were associated with COVID‐19 pneumonia. Children aged 5–18 years, underlying neurological disease, a history of COVID‐19 pneumonia, and the delta period were associated with long COVID.ConclusionsPediatric COVID‐19 patients presenting with respiratory symptoms who are obese or have been exposed to household members with COVID‐19 should be tested for COVID‐19. COVID‐19 patients who are obese, younger than five years old, or who present with shortness of breath, productive cough, or chest pain should be evaluated for pneumonia. COVID‐19 patients with a history of COVID‐19 pneumonia or underlying neurological disease should receive follow‐up for long COVID.