Background An infectious disease caused by a new type of coronavirus that can manifest as an acute respiratory infection was discovered in China in mid-December 2019 and soon spread throughout the country and to the rest of the world . Although chest X-rays are the initial imaging technique of choice for low respiratory infections with or without dyspnea, few articles have reported the radiologic findings in children with COVID-19 . Objective To describe the clinical, laboratory, and chest X-ray findings in pediatric patients with signs and symptoms of respiratory infection attended at our hospital in March 2020 . To analyze the frequency of COVID-19 compared to other respiratory infections, and to describe the radiologic manifestations of COVID-19 in pediatric patients . Material and methods This cross-sectional observational study included all children with clinical manifestations of respiratory infection (fever, rhinorrhea, cough, and/or dyspnea) that required chest X-rays in our hospital between March 1 and March 31 . Results A total of 231 pediatric patients (90 (39 %) girls and 141 (61 %) boys; mean age, 4 y, range 1 month – 16 years) underwent chest X-rays for suspected respiratory infections . Most (88.4 %) had mild symptoms; 29.9% had a family member positive for COVID-19 with symptoms similar to those of the patient . Nasal and/or throat swabs were analyzed for SARS-CoV-2 with PCR in the 47 (20.3 %) children who presented at the emergency department; 3 (6.3 %) of these were positive . Microbiological analyses were done in 85 (36.8 %) of all patients, finding infections due to pathogens other than SARS-CoV-2 in 30 (35.3 %). One of the patients with a PCR positive for SARS-CoV-2 had urine infection due to E. coli and blood culture positive for S. viridans . Abnormalities were observed on X-rays in 73.2% of the patients . Peribronchial thickening was the most common abnormal finding, observed in 57% of patients . Parenchymal consolidations were observed in 38.5%, being bilateral in 29.2% and associated with pleural effusion in 3.3% . The interstitial lines were thickened in 7.3%, and 7.3% had ground-glass opacities . Conclusion During March 2020, COVID-19 and other symptomatic respiratory infections were observed . The radiologic pattern of these infections is nonspecific, and chest X-rays alone are insufficient for the diagnosis . Children with clinical manifestations compatible with COVID-19 (with or without PCR confirmation of infection by SARS-CoV-2) had mild symptoms and most did not require admission or invasive mechanical ventilation . In a context of community transmission, the absence of a known epidemiological antecedent should not be a contraindication for PCR to detect SARS-CoV-2.