Objectives: We aimed to determine the bronchoscopic features of children with severe Mycoplasma pneumoniae pneumonia (SMPP), and correlation with obliterative bronchitis (OB), so as to help early clinical evaluation and treatment of pediatric SMPP. Methods: 213 pediatric SMPP cases admitted to Beijing Children’s Hospital were included. Medical records and bronchoscopic manifestations at different SMPP stages were retrospectively analyzed . Results: Of 213 acute-stage pediatric SMPP patients, bronchoscopy revealed 22 cases (10.3%) with subacute-stage or recovery-stage OB, for an OB incidence rate in cases with mucous embolus of 48.8% (22/47), a significantly higher rate than the rate without mucous embolus (0/166, 0%) (P < 0.001). Notably, the OB incidence rate for children undergoing bronchoscopy within 10 days (9/142, 6.3%) of SMPP onset was significantly lower than in children undergoing bronchoscopy 10 days post-disease onset (13/71, 76.5%) (P < 0.007). Conclusions: In pediatric SMPP patients, airway mucus and debris from epithelial necrosis and exfoliation can block airway subbranches, readily leading to OB.