OBJECTIVE: To present a review of the current diagnostic and therapeutic approach to the major conditions found in pediatric emergency department, which course with acute respiratory tract disfunction, stressing some clinical and epidemiological characteristics that are useful to the pediatrician in the differential diagnosis.METHODS: Outstanding articles related to the subject were selected after literature review of the last 20 years, using Md Consult, Medline and Lilacs databases.RESULTS: Many diseases can produce respiratory disfunction. Taking into account only those with acute symptoms, infectious and/or inflammatory causes predominate. History, examination findings and at least a chest X-ray are almost always sufficient for the diagnosis, but, sometimes other complimentary tests are necessary.CONCLUSIONS: If not properly treated, acute respiratory emergencies can result in significant morbidity and mortality. Any pediatrician taking part in an emergency team has to obtain respiratory management skills and knowledge concerning distinctive aspects and severity estimation of the several respiratory diseases.