Background and Aim: Acute lower respiratory infection (ALRI) is one of the leading causes of illness and death in children below 5 years of age. Anemia is one of the most widespread public health problems, especially in developing countries[2]. We aim to study the relationship between anemia as a risk factor and acute lower respiratory tract infections in Egyptian preschool children aged 6 months to 6 years. Subjects and methods: A case-control study was conducted on a total number of 172 infants and children aged 6 months to 6 years; in the period from January 2013 to  December 2013, we recruited 86 cases hospitalized for lower respiratory tract infections in Children Hospital, Zagazig University comprising all newly diagnosed cases during the defined time period of the study (incident cases) to ascertain the temporal sequence of exposure and disease. 86 healthy controls without any respiratory problems, age and sex matched were selected by simple random sampling from the general population that gave rise to the cases . All patients were subjected to detailed history taking ( including past medical or pharmacy records), full clinical examination, and investigations including CBC, Iron profile: serum ferritin, total iron binding capacity and serum iron for all children. CRP and Chest X ray are done for cases only. Results: The percentage of anemia was higher among case than control, with 81.4 % of hospitalized cases and 32.5%of healthy controls and the percent of iron deficiency anemia was higher in cases than controls 69.8% and 23.2% respectively with a significant P-value of 0.001.There were significant lower medians of serum iron, ferritin and transferrin saturation in cases than controls with highly and significant higher total iron binding capacity (TIBC) in cases than controls , also There's significant lower serum iron and transferrin saturation in anemic cases than anemic controls with no significant difference as a regard TIBC and serum ferritinApproval of ethical committee in college, and written consent from patients′ parents were obtained. Conclusion: we can conclude that anemia especially IDA is a risk factor for acute lower respiratory tract infections among Egyptian preschool children.