In the packed paediatric emergency room of a Lahore public hospital, parents holding sick children lined up for treatment this week, part of a surge of young patients caused by the air pollution crisis in Pakistan’s second most populous city. Health officials estimated there has been at least a 50% rise in paediatric patients due to respiratory issues exacerbated by poor air quality in the last month. Lahore, known historically as a city of gardens, is now choking with toxic smog that placed it as the world’s worst for air quality last year. As cooler temperatures took hold in November, air quality levels spiralled. Twenty-four of the last 30 days had ‘hazardous’ or ‘very unhealthy’ air quality, according to Swiss group IQAir. The UNICEF states that globally outdoor air pollution caused 154,000 deaths of children aged below five in 2019. In Pakistan, it is one of the top five causes of death among the entire population, with young children being the most severely affected. Children are more vulnerable to air pollution due to their developing organs and faster breathing rate. The provincial government in Lahore has taken measures to address the issue, including partial lockdowns, mask campaigns, and research into cloud-seeding. Crop burning, poor quality fuel, and industrial activities were identified as contributing factors to the pollution problem. The government is also seeking collaboration with India and China to improve air quality. Pediatric hospitals are overwhelmed with the increasing burden of respiratory issues, placing young children at the highest risk.