Acute Respiratory Infections in Children: A Narrative Perspective on Integrated Primary-Hospital Care in Italy

Acute respiratory infections (ARIs) remain one of the leading causes of pediatric consultations, emergency department visits, and hospital admissions worldwide, imposing a substantial clinical, organizational, and economic burden on healthcare systems. Although most ARIs are self-limiting viral illnesses, their high incidence during childhood continues to challenge both primary care pediatricians and hospital services. In recent years, the epidemiology and prevention of pediatric respiratory infections have evolved considerably following the COVID-19 pandemic and the introduction of nirsevimab immunization against RSV, while RespiVirNet has strengthened national respiratory-virus surveillance. These developments reinforce the need for integrated models of care. This narrative perspective discusses the current epidemiology and burden of pediatric ARIs, predominantly within the Italian healthcare setting, and examines the complementary roles of family and hospital pediatricians in clinical assessment, risk stratification, appropriate referral, and continuity of care. Particular attention is paid to antimicrobial stewardship and strategies to reduce inappropriate antibiotic prescribing. Preventive strategies, including RSV prevention and influenza, pneumococcal, and pertussis vaccination, are also considered as integral components of coordinated pediatric respiratory care. Finally, we discuss how surveillance, preventive interventions, shared referral criteria, structured information transfer, and measurable quality indicators could support more coordinated primary-hospital care and provide a framework for prospective evaluation.