Background Respiratory infection is a common trigger for the episode of alveolar hemorrhage in the pediatric diffuse alveolar hemorrahge (DAH). Whereas, a futher detailed study hasn’t been conducted. The aim of this study was to explore the etiological spectrum, clinical features, treatment strategies and outcomes of the respiratory infection induced episode of alveolar hemorrhage (RIIEAH) in the pediatric DAH. Methods The cases of pediatric DAH who had RIIEAH and a definite etiological diagnosis were included. A retrospective study was conducted. Results 1. A total of 16 cases with 21 RIIEAHs were included. Twelve RIIEAHs occurred at the unstable stage, 6 RIIEAHs occurred at the stable stage and 3 RIIEAHs occurred at the end stage. All the RIIEAHs with respiratory failure (n=5) and requirment of invasive mechanical ventilation (n=3) occurred at the unstable or end stage. 2. In the majority of the RIIEAHs (n=19), etiological diagnosis was identified by detecting the nucleic acid of the pathogens. Of these, bronchoalveolar lavage fluid was the most commonly used specimen in 12 RIIEAHs. The majority of the RIIEAHs (n=19) were caused by a single pathogen including mycoplasma pneumoniae (Mp) in 7 RIIEAHs, coronavirus (CoV) in 3 RIIEAHs, haemophilus influenzae (Hi) in 3 RIIEAHs, chlamydia pneumoniae in 2 RIIEAHs, human metapneumovirus in 2 RIIEAHs, acinetobacter baumannii in 1 RIIEAH and pueumocystis carinii in 1 RIIEAH. The rest 2 RIIEAHs were caused by the mixed pathogens including klebsiella pneumoniae and streptococcus pneumoniae in 1 RIIEAH, rhinovirus and CoV in 1 RIIEAH. 3. The majority of the RIIEAHs (n=19) presented with prodromal symptoms and most of them (n=15) occurred within 3 days from the prodromal symptoms. Either worsening anemia or hemoptysis was found in 13 RIIEAHs and dyspnea was found in 9 RIIEAHs. All the 12 RIIEAHs in which bronchosopy had been performed presented with bleeding on bronchoscopy. 4. An intensive glucocorticoid therapy was administrated in the 19 RIIEAHs and a targeted anti-infection treatment was administrated in the 11 RIIEAHs. The majority of the RIIEAHs (n=19) resolved, whereas there was 1 case death. Conclusions 1. RIIEAH could be caused by a varity of pathogens and could occur at any disease stage of pediatric DAH. 2. It usually occurred at the early stage of respiratory infection and presented with worsening anemia or hemoptysis. 3. Bronchoscopy had a good diagnostic value for RIIEAH and idenifying the etiology. 4. An intensive glucocorticoid therapy seemed to be effective and necessary.