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Background  Associations between ambient air pollution and child health outcomes have been well documented in developed countries such as the United States; however, only a limited number of studies have been conducted in developing countries. This study aimed to explore the acute effects of five ambient air pollutants (inhalable particles [PM 10 ], fine particles [PM 2.5 ], sulfur dioxide [SO 2 ], nitrogen dioxide [NO 2 ] and 0zone [O 3 ]) on children hospital outpatients with respiratory diseases in Shijiazhuang, China.    Methods  Three years (2013–2015) of daily data, including cause-specific respiratory outpatient records and the concentrations of five air pollutants, were collected to examine the short-term association between air pollution and children’s respiratory diseases; using a quasi-Poisson regression generalized additive model. Stratified analyses by season and age were also performed.    Results  From 2013 to 2015, a total of 551,678 hospital outpatient records for children with respiratory diseases were collected in Shijiazhuang, China. A 10 μg/m 3  increase in a two-day average concentration (lag01) of NO 2 , PM 2.5 , and SO 2  corresponded to an increase of 0.66% (95% confidence interval [CI]: 0.30–1.03%), 0.13% (95% CI: 0.02–0.24%), and 0.33% (95% CI: 0.10–0.56%) in daily hospital outpatient visits for children with respiratory diseases, respectively. The effects were stronger in the transition season (April, May, September and October) than in other seasons (the hot season [June to August] and the cool season [November to March]). Furthermore, results indicated a generally stronger association in older (7–14 years of age) than younger children (< 7 years of age).    Conclusions  This research found a significant association between ambient NO 2 , PM 2.5 , and SO 2  levels and hospital outpatient visits in child with respiratory diseases in Shijiazhuang, China.

Acute effects of ambient air pollution on outpatient children with respiratory diseases in Shijiazhuang, China