BACKGROUND: Recurrent respiratory tract infections (RRTIs) in children represent a significant clinical challenge. Although some studies have identified potential risk factors, a comprehensive and systematic overview is lacking. OBJECTIVE: This analysis is carried out to provide more advanced evidence to guide future prevention and health care. METHODS: This study (PROSPERO: CRD42024576464) was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published in English. Subgroup analysis, sensitivity analysis, and publication bias assessments were performed. Data analysis was conducted using Stata 17, and GRADE was employed to assess the quality of evidence. The risk factors identified in the positive results were discussed qualitatively. RESULTS: A total of 29 studies covering 639,078 children were included. Some risk factors: asthma (OR = 3.08, 2.06-4.62), breastfeeding <
6 months (OR = 1.26, 1.04-1.52), DCC: day care center (OR = 1.50, 1.16-1.93), have siblings (OR = 1.26, 1.00-1.59), ETS: Environmental tobacco smoke (OR = 1.13, 1.00-1.27), snoring (OR = 1.49, 1.16-1.93) got positive result. CONCLUSION: This analysis identifies several key risk factors for RRTIs in children, providing enhanced evidence for prevention and management strategies. In particular, asthma warrants closer attention, given its strong association with respiratory infections in pediatrics.