Aim: To compare the AIOS score with the radiological findings in children with respiratory disease. Material and methods: Total 50 Children in the age group of 2 months -59 months with fever less than 3 days, with cough or difficult breathing with any of the following: Fast breathing, chest in drawing, stridor in calm child, grunting, lethargy, convulsions, inability to drink were included in this study. Children with Illness duration >2 weeks, respiratory distress with prominent wheezing, upper respiratory infections with less severe respiratory symptoms, ex; acute otitis media, acute pharyngitis etc. were excluded from this study. Results: The 50 children who fit in the inclusion criteria were included in this study in and scored according to acute illness observation scale. There were 5 children who scored 10 and showed no clinical features of respiratory distress. In the 12 children who scored 11-15 there was mild to moderate respiratory distress and there were 33 children with severe respiratory distress who scored >16. Among the 50 children 6% of the children had normal x-rays. Hyperinflation pertinent to bronchiolitis was seen in 26 children, End point consolidation (include dense opacity that may be a fluffy consolidation) suggestive of lobar pneumonia was present in 17 patients (34%). Non end point infiltrates defined as linear andpatchy densities with peribronchial thickening and many areas of atelectasis pertinent to bronchopneumonia was seen in 12 patients (24%). Conclusion: AIOS scoring is useful in predicting abnormal x-ray findings and severity of disease in respiratory illness in 2-59 months old children.