OBJECTIVE: To evaluate the effectiveness of the flexible bronchoscopy in the diagnosis and treatment of refractory pneumonia among children. METHODS: Sixty children with refractory pneumonia were randomly divided into two groups: lavage and control (n=30 each). The control group received conventional medical treatment. The lavage group was given flexible bronchoscopy besides conventional medical treatment. The therapeutic effects were compared between the two groups. The results of bacterial culture and detection of antibodies against Mycoplasma pneumoniae in bronchoalveolar lavage fluid (BALF) were observed. RESULTS: The coincidence of bacterial culture results between BALF and sputum samples was 63.3%, and there were no significant differences in the positive bacterial culture results between them. The coincidence of PCR test for antibodies against Mycoplasma pneumoniae between BALF and serum samples was 73.3%. The results of Fisher's exact test showed the positive rate of Mycoplasma pneumoniae antibodies of BALF was higher than that of serum (P<0.05). The effective rate in the lavage group was significantly higher than that in the control group (97% vs 73%; P<0.01). CONCLUSIONS: The flexible bronchoscopy is useful for the diagnosis and treatment of refractory pneumonia in children.