Objective To analyze the effect of gamma globulin combined with terbutaline sulfate in the treatment of children with respiratory syncytial virus (RSV) infectious pneumonia. Methods: The clinical data of 111 children with RSV infectious pneumonia admitted to our hospital from June 2022 to October 2024 were retrospectively collected. According to different treatment regimens, the children were divided into the control group (treated with terbutaline sulfate, 54 cases) and the study group (treated with terbutaline sulfate combined with gamma globulin, 57 cases). The therapeutic effects, symptom improvement time, adverse reactions, lung functions [respiratory rate (RR), tidal volume per kilogram (VT/kg), peak-to-time ratio (TPTEF/TE), peak-to-volume ratio (VPTEF/VE)], as well as monocyte Toll-like receptor 4 (TLR4) and the expression level of myeloid cell initiating receptor-1 (sTREM-1) and? cluster differentiation antigen 64 (CD64) were statistically compared between the two groups. Results: The total effective rate of treatment in the study group was significantly higher than that in the control group (P < 0.05). The time for wheezing to be relieved, the time for coughing to disappear, the time for body temperature to return to normal, and the time for wheezing to subside in the study group were all significantly shorter than those in the control group (P < 0.05). After treatment, the VPTEF/VE, TPTEF/TE, and VT/kg in both groups were significantly increased compared with those before treatment, and the RR was significantly decreased compared with that before treatment. Moreover, the change amplitudes of VPTEF/VE, TPTEF/TE, VT/kg, and RR in the study group after treatment were significantly greater than those in the control group (P < 0.05). After treatment, the positive rate of TLR4, the expression level of TLR4 mRNA, the levels of sTREM-1 and CD64 in both groups were significantly lower than those before treatment, and the positive rate of TLR4, the expression level of TLR4 mRNA, the levels of sTREM-1 and CD64 in the study group after treatment were significantly lower than those in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion: Gamma globulin combined with terbutaline sulfate in the treatment of children with RSV infectious pneumonia can improve the therapeutic effect, promote symptom improvement, enhance lung function, inhibit inflammatory responses, and has a relatively high safety.