Nearly half of all American children, 46% of people under age 18, are living in places with unhealthy levels of air pollution. This troubling finding from the American Lung Association's 27th annual "State of the Air" report reveals that despite decades of clean air protections, millions of young people face immediate and long-term health risks from polluted air.

Why Are Children More Vulnerable to Air Pollution?

Children's bodies are fundamentally different from adults when it comes to air pollution exposure. Their lungs, brains, and immune systems are still developing, which means even small amounts of pollution can cause greater harm than it would in adults. This vulnerability begins before birth, as exposure to polluted air during pregnancy can impair fetal growth and increase the risk of infant mortality or preterm birth.

Several factors make children especially susceptible to breathing problems from poor air quality:

• Smaller body size: Children take in higher doses of pollution for their size with every breath, meaning their exposure is more concentrated than an adult's.
• Increased outdoor time: Kids spend more time playing outside than most adults, extending their exposure to outdoor pollutants.
• Ground-level proximity: Because children are closer to the ground, they breathe in more vehicle exhaust and dust, which settle at lower heights.
• Faster breathing rate: Children breathe more rapidly than adults, pulling in more polluted air per minute.

When children breathe polluted air regularly, it can block small airways, interfere with lung growth, and disrupt normal brain development. Over time, these injuries can limit a child's ability to learn, play, and thrive.

What Health Problems Does Air Pollution Cause in Kids?

The health consequences of poor air quality for children are both immediate and long-lasting. Short-term exposure increases the risk of ear, nose, throat, and lung infections, which in turn leads to more doctor and hospital visits. Research has found that pollution can change how a child's immune system works, leaving them more vulnerable to illness.

For children with asthma, the risks are even more severe. Unhealthy air can worsen asthma symptoms and trigger flare-ups, leading to missed school days and emergency room visits. According to the 2026 "State of the Air" report, nearly 2.4 million children with asthma live in counties that received an "F" grade for at least one pollutant.

Long-term exposure to air pollution is associated with impaired lung function, increased risk of certain cancers, and cognitive effects that can make it harder for children to concentrate and succeed in school.

How Is Climate Change Making Air Quality Worse?

Climate change is making it increasingly difficult to control air pollution and is threatening to reverse decades of progress. Higher temperatures make it easier for ozone, a key ingredient in smog that makes it harder to breathe, to form. Extreme heat often brings stagnant air that allows pollution to linger and accumulate in communities.

Intense droughts and a higher frequency of wildfires release enormous amounts of particle pollution, spreading unhealthy smoke across huge regions. Wildfire smoke also contains pollution "precursors" that further contribute to smog formation. For children, this means more days when it's unsafe to play outside, more missed activities and school days, and greater long-term health risks.

Steps to Protect Your Family From Poor Air Quality

• Check daily air quality forecasts: Visit AirNow.gov before planning outdoor activities to see pollution levels in your area and limit time outside when pollution is high.
• Improve indoor air quality: Keep windows closed on high-pollution days, use air purifiers if available, and reduce sources of indoor pollution like new carpets or paint fumes.
• Reduce household pollution: Conserve energy at home and choose cleaner transportation options when possible to help reduce the pollution that contributes to unhealthy air in your community.
• Monitor respiratory symptoms: Watch for signs of breathing problems or asthma flare-ups on days with poor air quality and have a plan to manage them.

In South Dakota, the situation reflects broader national trends. The American Lung Association found that Sioux Falls ranks as the 13th cleanest city for year-round particle pollution, yet received a D grade for short-term fine particle pollution and ranked 32nd worst in the nation for ozone pollution. The report also found that 91,561 kids in South Dakota are breathing unhealthy levels of air pollution.

"During the summertime, certainly with the change of the season plus pollen and dust being blown around by the wind, then we can certainly have increased effect of asthma and COPD exacerbations," said Dr. Paul Berger, a pulmonologist at Sanford.

Dr. Paul Berger, Pulmonologist at Sanford

Dr. Berger also emphasized that children's developing bodies make them particularly vulnerable. "The key thing with children is that their lungs and their bodies are still developing," he explained. "For adults, it's not just a specific organ system. When you start breathing in air that has poor quality, then you start having issues with inflammatory responses that don't just involve the lungs".

Dr. Berger also

The broader picture is concerning. Nationally, 152 million people, or 44% of the U.S. population, reside in places that receive failing grades for ozone or particle pollution. More than 129 million people live in areas with unhealthy levels of ozone, while 61.5 million people live with unhealthy levels of short-term particle pollution.

While the challenges are serious, there is still reason for hope. Clean air policies work, and families can take meaningful steps to protect their children while also advocating for healthier communities. One of the most powerful tools is sharing real-life experiences about air pollution with policymakers. Stories from families about managing asthma symptoms during smoggy days or keeping children indoors during wildfire smoke help policymakers see the real-life impact on communities across the nation.

Every child deserves the chance to grow, learn, and play while breathing clean air. By staying informed about air quality, taking protective steps at home, and advocating for stronger clean air protections, families can help ensure that future generations have healthier air to breathe.