Primary aim was to review severe acute respiratory infections (SARI) hospitalisations caused by respiratory syncytial virus (RSV) in children aged < 2 years in paediatric hospitals in Australia. Secondary aims included RSV subtyping, assessing RSV seasonality and contributing to the World Health Organisation's RSV surveillance programme.We prospectively reviewed the medical records of children (< 2 years of age) with a confirmed SARI who were admitted to one of four major Australian paediatric hospitals and had a respiratory sample analysed by Polymerase Chain Reaction (PCR). A detailed dataset was completed for RSV positive cases.Between 1 January 2021 and 31 December 2022, 2290 RSV (laboratory-confirmed) admissions were identified (53.4% of all SARI admissions). Approximately 50% of all RSV cases were aged 0-6 months. RSV-A predominated in 2021 with peak infections observed in summer while in 2022 RSV-B predominated with peak infections in the more traditional winter months. The median total length of stay (LOS) for RSV positive admissions was 46 h (IQR: 22-82 h). 9% of these children required an ICU admission with a prolonged median LOS 68 h (IQR: 40-112 h). Respiratory support utilisation was consistent over the 2 years. 1.8% required mechanical ventilation; 4.6% continuous positive airway pressure; 23.3% high flow oxygen; and 50.8% low flow oxygen.RSV in children continues to cause a significant disease burden at Australian tertiary paediatric centres. Ongoing hospital surveillance is required to document the impact of RSV preventative therapies that have become available in 2024.