The causes of lower respiratory tract infections in 1544 children attending a Japanese hospital over a period of 7 years were investigated. Both cultivation and two serological techniques were used to detect Mycoplasma pneumoniae whereas viral involvement was investigated only by serology. Pathogens were identified in 52% of 1175 patients with pneumonia and 36% of 369 patients without pneumonia. Mycoplasma pneumoniae infection was specifically diagnosed in 414 (26.8%) of the 1544 patients. Respiratory syncytial virus (RSV) was dominant in children up to 2 years of age. By the age of 3 years, M. pneumoniae was equalling it in incidence and became the main pathogen in older groups. It is suggested that M. pneumoniae may be more important in the 3-6 years age group than hitherto suspected. These observations may influence the choice of antibiotics for treating lower respiratory tract infections in childhood.