Air pollution continues to cause over 1,200 premature deaths per year among under-18s in Europe, and increases the risk of chronic disease later in life, according to the EU environmental agency.
Despite recent improvements, many European countries still have key air pollutants above World Health Organization guidelines, particularly central and eastern Europe and Italy.
A study in over 30 countries, including EU member states, did not cover major industrial nations, suggesting overall death tolls for the continent could be higher.
In 2020, 238,000 people in the EU, Iceland, Liechtenstein, Norway, Switzerland and Turkey died prematurely because of air pollution, according to the agency.
As a result, it has urged authorities to focus on improving air quality particularly around schools, nurseries, sports facilities and mass transport hubs.
Fine particulate matter, nitrogen dioxide and ozone are considered the worst air pollutants.