| Summary: | <i>Background</i>: Environmental factors determine children’s health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. <i>Objective</i>: This study aimed to assess the burden of childhood disease due to environmental risks across the European Union. <i>Methods</i>: We conducted an environmental burden of childhood disease assessment in the 28 countries of the EU (EU28) for seven environmental risk factors (particulate matter less than 10 micrometer of diameter (PM<sub>10</sub>) and less than 2.5 micrometer of diameter (PM<sub>2.5</sub>), ozone, secondhand smoke, dampness, lead, and formaldehyde). The primary outcome was disability-adjusted life years (DALYs), assessed from exposure data provided by the World Health Organization, Global Burden of Disease project, scientific literature, and epidemiological risk estimates. <i>Results</i>: The seven studied environmental risk factors for children in the EU28 were responsible for around 211,000 DALYs annually. Particulate matter (PM<sub>10</sub> and PM<sub>2.5</sub>) was the main environmental risk factor, producing 59% of total DALYs (125,000 DALYs), followed by secondhand smoke with 20% of all DALYs (42,500 DALYs), ozone 11% (24,000 DALYs), dampness 6% (13,000 DALYs), lead 3% (6200 DALYs), and formaldehyde 0.2% (423 DALYs). <i>Conclusions</i>: Environmental exposures included in this study were estimated to produce 211,000 DALYs each year in children in the EU28, representing 2.6% of all DALYs in children. Among the included environmental risk factors, air pollution (particulate matter and ozone) was estimated to produce the highest burden of disease in children in Europe, half of which was due to the effects of PM<sub>10</sub> on infant mortality. Effective policies to reduce environmental pollutants across Europe are needed.
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