Background: Acute Lower Respiratory Tract Infections (ALRTIs) remain a leading cause of morbidity and mortality in children under five years, particularly in low- and middle-income countries, where socioeconomic and environmental factors contribute to disease burden. Aim: To determine the distribution pattern of ALRTIs and associated risk factors among children under five years admitted to Children Hospital, Kirkuk City. Patients and Methods: This descriptive cross-sectional, hospital-based study was conducted in Kirkuk City from 1 November 2024 to 30 May 2025. A total of 241 children aged <5 years admitted with ALRTI (bronchitis, bronchiolitis or pneumonia) were consecutively enrolled. Data were collected using a structured questionnaire covering demographic characteristics, feeding practices, household smoking exposure, vaccination status, past medical history and clinical features. Data were analyzed using SPSS v26; categorical variables were presented as n (%) and associations were tested using Chi-square/Fisher’s exact test, with p<0.05 considered significant. Results: Infants aged 0-12 months represented 165 (68.46%) of cases. Males were more frequently affected than females (139 [57.68%] vs. 102 [42.32%]) and urban residence predominated (179 [74.27%]).  Nearly  half  of  mothers  were  illiterate (111 [46.06%]).   Bottle   feeding   was   the   most   common   feeding   type (78 [32.36%]), while exclusive breastfeeding was low (35 [14.52%]). Household smoking exposure was reported in 127 (52.70%) children. The most common presenting features were productive cough (231 [95.85%]), wheezing (219 [90.87%]) and fever (201 [83.40%]). Most children presented after 4-7 days of illness (114 [47.30%]) and required short hospital stays of 1-3 days across age groups. Bottle-fed children had the longest mean illness duration (8.71±5.42 days) compared with exclusively breastfed children (6.68±5.18 days) (p = 0.023). Conclusion: ALRTIs in Kirkuk predominantly affected infants, males and urban residents. Low maternal education, household smoking exposure and low exclusive breastfeeding rates were prominent among hospitalized cases. Breastfeeding was associated with shorter illness duration, supporting its protective role. Strengthening health education, promoting exclusive breastfeeding and enforcing smoke-free home practices are recommended to reduce ALRTI burden.