Abstract: OBJECTIVE To preliminarily explore the levels of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) and the role of Toll-like receptor 4 (TLR4) signaling pathway in children with respiratory syncytial virus (RSV) infectious pneumonia. METHODS Totally 80 children with RSV infectious pneumonia who were treated in the Third People's Hospital of Panzhihua from Jan 2017 to Jan 2019 were chosen as the case group, meanwhile, 60 children with common pneumonia were set as the common pneumonia group, and 50 healthy children who received physical examination were assigned as the control group. The levels of TNF-α and IL-1β were determined by using enzyme-linked immunosorbent assay, the positive rate of TLR4 protein in monocytes was detected with the use of flow cytometry, and the expression of TLR4 signaling pathway was detected by means of real-time PCR. RESULTS The levels of serum TNF-α and IL-1β of the case group were significantly higher than those of the common pneumonia group and the control group, and the levels of above indexes of the common pneumonia group were significantly higher than those of the control group (P<0.05). The expression levels of TLR4 mRNA and A20 mRNA in monocytes were significantly higher in the case group than in the common pneumonia group and the control group, and the expression levels of above indexes were significantly higher in the common pneumonia group than in the control group (P<0.05). The positive rate of TLR4 protein in monocytes of the case group was significantly higher than that of the common pneumonia group and the control group, and the positive rate of TLR4 protein in monocytes of the common pneumonia group was significantly higher than that of the control group (P<0.05). CONCLUSION The children with RSV infectious pneumonia show high expression levels of serum TNF-α and IL-1β, and the TLR4 signaling pathway in monocytes may be involved in inflammatory response of RSV infectious pneumonia.