Aim: This study was investigating the effect of prescribing zinc sulphate on improving the clinical symptoms of pneumonia in 2 to 59 months of children’s. Methods: This Case-Control study was done in the Department of Pediatrics, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for 1 year. Among 300 patients divided into two equal groups. 150 Children between the age of 2 months to 59 months and children with Acute Lower Respiratory Tract infection were include in case group and 150 children for control group. The details of blood investigations and imaging for confirmation of clinical diagnosis were also noted during the stay of the patient in the hospital. The serum zinc estimation was done by using colorimetric test. Results: The mean age of cases was 1.68±1.547 yrs and that of controls was 1.81±1.63 yrs. The Sex wise distribution of the cases and controls consisted of 93(62%)of cases being male and 57(38%) being female as compared to 84(56%) of controls being male and 66(44%) being female. On comparison, the distribution of cases and controls in this study according to age, sex, nutritional status and socioeconomic status was statistically not significant. The Mean serum zinc levels in the cases and controls, after comparison, were found to be significantly different [p=0.0001], with mean value for the cases being 58.78 ± 12.73 ug/dl as compared to 85.22 ± 13.89 ug/dl for the controls. A total of 39 cases and controls (26%) were found to have deficiency of zinc, of which majority (90%) were cases (normal range of 60 to 150 ug/dl). Severe Pneumonia group (Mean=42.35± 6.38 ug/dl) having significantly lower value than that of Pneumonia group (Mean=64.47±7.11 ug/dl). This is also reflected when we see serum zinc levels according to oxygen requirements, with cases managed on room air having mean of 63.97 ± 6.42 ug/dl, cases requiring supplemental oxygen by nasal prongs having mean of 60.33 ±9.52 ug/dl and cases requiring mechanical ventilation having mean of 39.78 ±7.23 ug/dl. The serum zinc analysis of patients according to outcome shows significantly lower zinc values (p value=0.0001) in cases who eventually died due to the ALRTI and its complications (n=13) as compared to those who got discharged after treatment (n=137). Conclusion: The serum zinc levels were found to be lower in risk factors of LRTI like poor nutritional status, anemia, vitamin A deficiency, low birth weight and formula fed patients.