Objective To analyze the correlation between anti N-methyl-D-aspartate receptor (NMDAR) encephalitis prodromal events and clinical features in children. Methods A retrospective analysis was conducted on 107 pediatric patients with anti-NMDAR encephalitis from January 2014 to March 2019, to examine the correlation between prodromal events and clinical characteristics in these children. Results Of the 107 patients, 52 cases (48.6%) had prodromal events, predominantly consisting of infectious prodromal events (73.1%, 38 out of 52). A comparative analysis revealed that patients with a history of intracranial infection as a prodromal event were significantly younger at onset (6.0±4.7 years) compared to those without such a history (6.4±2.9 years, P=0.006). Additionally, these patients had a markedly higher incidence of limb paralysis (P=0.038) and sleep disorders (P=0.037). The hospital stay was prolonged for patients with intracranial infection prodromal events (P=0.001). Furthermore, these patients exhibited higher modified Rankin Scale (mRS) scores prior to treatment (P=0.008) and required more courses of intravenous immunoglobulin (IVIG) treatment (P=0.011). Conclusions Pediatric patients with anti-NMDAR encephalitis and prodromal events, particularly those with intracranial infections, displayed distinct clinical profiles. They were more likely to present at an earlier age with increased rates of limb paralysis and sleep disorders, necessitating longer hospital stays and additional IVIG treatments.