Recurrent lower respiratory tract infections in children are caused by a deficiency in the host defense or an underlying pulmonary disorder which may result from structural or functional alterations. Aspiration syndromes, congenital defects, airway clearance disorders and immune deficiency are the main categories. Careful evaluation with good history and examination provide important leads to limit the radiological and laboratory work up to the most relevant investigations. Some of the structural abnormalities are amenable to cure; however, secondary events need careful management of the underlying lung disorder to give the best quality of life to these children.