The aim of this study was to analyze the clinical characteristics of Mycoplasma pneumoniae (MP) infection in children and provide a basis for the diagnosis and treatment of MP and refractory Mycoplasma pneumoniae pneumonia (MPP) in children. A total of 112 children with MPP admitted to Luoyang Maternal and Child Health Hospital between January 31, 2023 and December 31, 2023 were studied, and their clinical characteristics were retrospectively analyzed, including children's general data, clinical symptoms, imaging changes, bronchoscopy, and laboratory data, including inflammatory factors such as C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), bacterial culture results of bronchoalveolar lavage or sputum, and results of MP culture and detection of MP drug resistance gene loci 23sRNA A2063G and A2064G. Among the 112 children with MPP included in the analysis, 48 were males (42.86%), 64 were females (57.14%), with an average age of 5.74 ± 2.62 years old, 55 cases were older than 6 years old (49.11%), 35 cases were 3 to 6 years old (31.25%), and 22 cases were <3 years old (19.64%), with the older children being the most; 103 cases were fever (91.96%), 94 cases were cough (83.93%), and 46 cases were dyspnea (41.07%). Fiber bronchoscopy showed that 112 cases were mucosal congestion and edema (100.00%), 69 cases were sputum embolism (61.61%), and 19 cases were mucosal erosion (16.96%); the incidence of CRP, PCT, IL-6, and bacterial infection in the MPP group were lower than those in the RMPP group (P < .05), and there was no significant difference in the mutation rate of 23sRNA A2063G and A2064G between the 2 groups (P > .05); logistic regression analysis showed that CRP, PCT, IL-6, alanine aminotransferase, lactate dehydrogenase, immunoglobulin A, IgG, and immunoglobulin M were the main influencing factors of RMPP (P < .05); the length of hospital stay, biochemical treatment of alanine aminotransferase, lactate dehydrogenase, cardiac troponin I, and inflammatory factors of CRP, PCT, and IL-6 in the bronchoalveolar lavage treatment group were lower than those in the general treatment group (P < .05). Children with MPP have more fever, cough, and dyspnea as the starting point, and mucosal congestion, edema, sputum embolism are the most common in bronchoscopy. Children with RMPP may be accompanied by decreased immune function and increased inflammation.