BACKGROUND: Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis in childhood. Respiratory symptoms can mask neurologic signs, leading to a delay in diagnosis. OBJECTIVES: We report this case to highlight the diagnostic difficulty in children suffering from GBS who have respiratory involvement as the main clinical findings on presentation. CASE REPORT: This case report describes a 9-year-old girl presenting with respiratory distress, weakness, limb pain, and hypertension. The severe respiratory involvement due to a Mycoplasma pneumoniae lung infection led to a delay in diagnosing GBS in this child. CONCLUSION: Unexplained weakness, together with respiratory involvement and associated dysautonomia, should support the possibility of GBS.