ABSTRACT. Objectives. The purpose of this study was to examine the association between ambient air pollution and hospitalization for respiratory infections among children who were younger than 15 years in Toronto during a 4-year period (1998 -2001).Methods. Exposures averaged during periods that varied from 1 to 7 days were used to assess the effects of air pollutants, including thoracic particulate matter (PM 10 ), fine (PM 2.5 ) and coarse (PM 10 -2.5 ) particulate matter, carbon monoxide (CO), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ), on hospitalization for respiratory infections. A case-crossover design was used to calculate odds ratios for the hospitalization adjusted for daily weather conditions with an incremented exposure corresponding to the interquartile range in air pollution exposures.Results. When particulate matter and gaseous pollutants were mutually taken into account, the effect remained pronounced for PM 10 -2.5 in both boys and girls. The adjusted odds ratio for 6-day average exposure to PM 10 -2.5 with an increment of 6.5 g/m 3 was 1.15 (95% confidence interval: 1.02-1.30) for boys and 1.18 (95% confidence interval: 1.01-1.36) for girls. The effect also remained for PM 10 in boys and for NO 2 in girls. PM 2.5 , CO, SO 2 , and O 3 showed no significant effects on hospitalization for respiratory infection in both genders when other pollutants were taken into consideration.Conclusion. Our study suggested a detrimental effect of relatively low levels of ambient particulate matter and gaseous pollutants, especially coarse particulate matter and NO 2 , on hospitalization for respiratory infections in children. Pediatrics 2005;116:e235-e240. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-2012; air pollution, coarse particulate matter, gaseous pollutants, hospitalization for respiratory infection, case-crossover analysis, risk assessment.ABBREVIATIONS. CO, carbon monoxide; SO 2 , sulfur dioxide; NO 2 , nitrogen dioxide; O 3 , ozone; PM 10 , thoracic particulate matter Ͻ10 m in aerodynamic diameter; PM 2.5 , fine particulate matter Ͻ2.5 m in aerodynamic diameter; TEOM, tapered element oscillating microbalance; PM 10 -2.5 , coarse particulate matter between 2.5 and 10 m in aerodynamic diameter; OR, odds ratio; CI, confidence interval; TSP, total suspended particles. L ower respiratory infection is a main cause of mortality and morbidity in children in developing countries. Morbidity from childhood respiratory infections is also high in developed countries. 1 Although respiratory infections in children are usually nonfatal in developed countries, they heavily burden the health care systems. 2 Additional progress in preventing the diseases will have a significant impact on children's health. 1 Although there is abundant evidence linking outdoor air pollution with respiratory symptoms, reduced lung function, bronchial reactivity, and asthma, the relationship of hospital morbidity for respiratory infections to a relatively low level of exposure to air pollution in children has...