Introduction: Respiratory viral infections cause a significant morbidity in children. Significance of isolation of multiple viruses in acute lower respiratory infections (ALRI) in children is not well characterized. The aim of this study was to compare demographics, resource utilization, and outcomes of patients with single versus multiple viral co-infections. Methods: This retrospective study was conducted by reviewing electronic records of patients hospitalized with positive respiratory viral panel within 48 hours of admission from 1/1/2015 to 12/31/2019. Outcome assessment included resource utilization, length of stay and costs. Univariate and multivariable analysis were performed. Results: A total of 2192 patients were included in this study. 16.4% of all patients had viral co-infections. Rhino/enterovirus comprised 49.2% of all identified viruses. Rhino/enterovirus and RSV were the most common co-infections (22.4%). Patients with coinfection were younger in age (median11.3 months). Intravenous antibiotics were prescribed in 29.4% with no difference in usage among the two groups. Patients with viral coinfections had a higher rate of high flow nasal cannula utilization, intubation, and length of stay (3 days [1,5] vs 2 days [1,4]). Overall mortality rate of study population was 0.3% with no difference between the two groups. Cost of care was higher for patients with coinfection but not significant after adjusting for confounders. Conclusion: Children with viral coinfection comprise a sizeable proportion of hospitalized children with bronchiolitis and have a higher severity of illness as suggested by increased use of high flow nasal cannula and hospital length of stay.