Introduction:
Smoking during the perinatal period disrupts the structure and development of children’s lungs, leading to alterations, reduced pulmonary function, respiratory infections, and frequent hospitalizations, particularly in children whose parents are smokers.

Objective:
This study aims to examine the impact of environmental exposure to tobacco smoke and the manifestation of respiratory infections in neonates, infants, and children.

Materials and Methods:
A literature review was conducted by searching scientific articles in electronic databases using keywords such as “smoking,” “perinatal period,” “respiratory,” “secondhand smoke exposure,” and “thirdhand smoke exposure,” among others.

Results:
Parental tobacco use, both prenatally and postnatally, along with secondary and tertiary exposure of children to tobacco smoke, is associated with adverse respiratory outcomes, including wheezing and asthma; bronchitis; bronchiolitis; persistent cough (lasting more than 3 weeks); otitis media and bronchopulmonary dysplasia. Due to respiratory infections, hospitalization of children in Neonatal Intensive Care Units (NICU), Pediatric Intensive Care Units (PICU), or Pediatric High Dependency Units (PHDU), respiratory support, and lifelong medication are often unavoidable. Prenatal maternal smoking significantly increases the risk of these diseases, while postnatal exposure exacerbates this risk. Extended breastfeeding appears to be a protective factor against these diseases, as many mothers tend to quit smoking during lactation.

Conclusions:
Respiratory health during the neonatal, infant, and childhood stages is severely impacted by the harmful effects of environmental exposure to tobacco smoke. Parental education and support for smoking cessation are essential to safeguard their children’s health. The role of healthcare providers is crucial and of utmost importance.