ABSTRACT Objective Severe pneumonia poses a significant global health challenge. This study aimed to evaluate the therapeutic effects of Traditional Chinese Medicine (TCM) pediatric Tuina for children suffering from severe pneumonia. Methods This study prospectively analyzed 180 children with severe pneumonia treated at our hospital from January 1, 2019, to December 31, 2024. Participants were randomly assigned to either the Tuina treatment group ( n = 90), which received pediatric Tuina therapy along with standard treatment, or the control group ( n = 90), which received standard treatment only. Outcomes compared between the groups included symptom improvement, inflammatory markers (CRP, PCT, WBC), pulmonary function (FEV1, FVC, PEF, MVV), and safety evaluation. Results The Tuina treatment group demonstrated a significantly higher symptom improvement rate ( p < 0.05) and shorter times for fever resolution, cough relief, and wheezing cessation compared to the control group within 5 days of intervention. Hospitalization duration was also reduced in the Tuina group ( p < 0.05). Post‐intervention, levels of inflammatory markers were lower, and pulmonary function indicators were higher in the Tuina group ( p < 0.05). No serious adverse reactions were reported, with the incidence of adverse reactions being 21.11% in the Tuina group and 24.44% in the control group ( p > 0.05). Conclusions Pediatric TCM Tuina serves as a highly effective and safe complementary treatment for children with severe pneumonia, markedly enhancing clinical symptoms, diminishing inflammation, boosting pulmonary function, and reducing the duration of hospital stay.