The Impact of Home Energy Efficiency Measures on Children’s Respiratory Health: A Scoping Review

<ns3:p>Background Children’s homes play a key role in shaping their respiratory health. Amid rising fuel poverty and Net Zero targets, the UK has implemented Home Energy Efficiency (HEE) measures such as insulation, double glazing, and heating upgrades. While these measures improve thermal comfort and reduce carbon emissions, they may inadvertently compromise indoor air quality, and consequently, respiratory health. Methods This scoping review explored the association between HEE measures and respiratory outcomes in children under 18 years of age. A systematic search was conducted across four electronic databases to identify relevant primary research studies published from 2011 to 2025. Eligible studies included interventional and observational designs evaluating HEE interventions and reporting at least one respiratory health outcome in a paediatric population. Two reviewers independently screened all records and extracted key data using a predefined template. Findings were summarised descriptively and narratively. Results A total of twenty-three studies met the inclusion criteria, all conducted in high-income countries. Thirteen studies focused on low-income households. Heating upgrades (n=13) and insulation (n=10) were the most frequently evaluated interventions. Nearly half of the studies (n=11) examined multi-component housing programmes, limiting the ability to isolate the effects of specific HEE measures. Despite this, 22 studies reported respiratory health improvements, including reduced asthma symptoms, hospital admissions, and school absences. Additionally, 13 studies observed reductions in indoor pollutant concentrations, including dampness and mould. However, a small number of studies (n=4) reported adverse outcomes where increased airtightness was not paired with adequate ventilation. Conclusion HEE measures are generally associated with improved respiratory outcomes in children. However, careful implementation is needed to avoid unintended harms. Further research is required to isolate the effects of individual HEE measures and extend the evidence base to low- and middle-income countries. These findings support the need for health-informed retrofit policies.</ns3:p>