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Asthma, allergy, and low parental education linked to recurrent respiratory infections in preschoolersRisk factors for frequent respiratory infections in preschool children
Jornal de pediatriaPublished November 6, 2026Study authors: Huang Haizhu, Chen Xiaozhan, Wang Yi, Wang Dongxu, Zhou ChuanlinPubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Recognize asthma, allergy, and low parental education as risk factors for recurrent respiratory infections in preschoolers.
This meta-analysis examined the prevalence of recurrent respiratory tract infections (RRTIs) and associated risk factors in preschool children, synthesizing data from 15,271 participants. The pooled prevalence of RRTIs was 24.14% (95% CI 0.23, 0.33).
Several factors were associated with increased odds of RRTIs: asthma (OR 3.84, 95% CI 1.97 to 7.47, P < 0.001), low parental education level (OR 3.17, 95% CI 1.76 to 5.69, P < 0.001), allergy (OR 2.27, 95% CI 2.06 to 2.51, P < 0.001), dietary bias (OR 2.10, 95% CI 1.37 to 3.24, P = 0.001), smoking co-resident (OR 1.83, 95% CI 1.44 to 2.32, P < 0.001), initial antibiotic use before 6 months (OR 1.70, 95% CI 1.50 to 1.93, P < 0.001), breastfeeding duration less than 6 months (OR 1.26, 95% CI 1.12 to 1.42, P < 0.001), and maternal BMI per 3 kg/m2 increment (OR 1.18, 95% CI 1.08 to 1.28, P < 0.001).
The authors note that the high prevalence of RRTIs and the identified risk factors provide evidence for targeted prevention and intervention strategies. However, the associations are correlational, and causality cannot be inferred. Limitations of the meta-analysis were not reported, and certainty of evidence was not assessed.
In practice, these findings may help clinicians identify children at higher risk based on factors such as asthma, allergy, parental education, and early antibiotic exposure, but further research is needed to confirm whether modifying these factors reduces RRTI incidence.
How this fits prior evidence
This meta-analysis extends prior coverage on pediatric respiratory infections by quantifying the prevalence of recurrent respiratory tract infections (24.14%) and identifying associated risk factors in preschool children. It aligns with previous findings that early antibiotic use may have downstream effects, as seen in the coverage of azithromycin and macrolide resistance, and with the interest in modifiable factors like breastfeeding and diet. However, unlike prior studies that focused on interventions such as probiotics or rapid testing, this analysis highlights sociodemographic and clinical associations, underscoring the need for targeted prevention strategies.
Parents of preschool children often worry about why their little ones seem to catch repeated respiratory tract infections. New research looking at over 15,000 children helps clarify what factors might make a child more likely to experience these frequent illnesses.
The study found that about 24 percent of preschool children suffer from these repeated infections. Several specific factors were linked to a higher risk. For example, children with asthma were much more likely to have frequent infections, and those with allergies also faced higher risks. Environmental factors played a role too, including living with someone who smokes and certain dietary habits.
Other factors included early use of antibiotics before six months of age and shorter periods of breastfeeding. The data also showed that maternal weight and lower parental education levels were linked to higher infection rates. While these findings show clear links between these factors and child health, they show associations rather than direct causes. Talk to your doctor to discuss how these specific risks might affect your child.
What this means for you:
Asthma, allergies, and environmental factors like secondhand smoke increase the risk of repeat respiratory infections.
Common questions
What conditions make a child more likely to get repeated respiratory infections?
Children with asthma are significantly more likely to experience repeated respiratory tract infections. Additionally, having allergies is a known risk factor. The study found that these conditions are linked to a higher prevalence of infections in the preschool population.
How do environmental factors affect a child's respiratory health?
Living with a smoking co-resident is a risk factor for repeated infections. The study also found that dietary bias and the use of antibiotics before the age of six months are linked to higher rates of respiratory tract infections in young children.
Do maternal health or habits affect a child's risk of infection?
Yes, the study found that a shorter breastfeeding duration of less than six months and higher maternal BMI were both linked to an increased risk of repeated respiratory tract infections in preschool children.
OBJECTIVE: To evaluate the prevalence and risk factors for recurrent respiratory tract infections in preschool children.
METHODS: Studies on RRTIs in preschool children were retrieved from PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, Wanfang, and VIP databases up to October 2025. Data was analyzed using Stata 15.0.
RESULTS: Ten studies involving 15,271 preschoolers were included. Meta-analysis showed that the overall prevalence was 24.14% [95% CI (0.23,0.33)].A total of 11 risk factors for RRTIs in preschool children were identified, including: asthma (I² = 93.8%) [OR = 3.84, 95% CI (1.97, 7.47), P < 0.001], allergy(I² = 0) [OR = 2.27, 95% CI (2.06, 2.51), P < 0.001], dietary bias (I² = 65%) [OR = 2.10, 95% CI (1.37, 3.24), P = 0.001], smoking co-resident(I² = 42.7%) [OR = 1.83, 95% CI (1.44, 2.32), P < 0.001], low parental education level(I² = 0) [OR = 3.17, 95% CI (1.76, 5.69), P < 0.001], initial use of antibiotics < 6 months(I² = 0) [OR = 1.70, 95% CI (1.50, 1.93), P < 0.001], maternal BMI per 3 kg/m² increment(I² = 0) [OR = 1.18, 95% CI (1.08, 1.28), P < 0.001], and breastfeeding duration < 6 months(I² = 0) [OR = 1.26, 95% CI (1.12, 1.42), P < 0.001].
CONCLUSION: The high prevalence (24.14%) of RRTIs in preschool children and the risk factors identified provide evidence for targeted prevention and intervention strategies.
