Objective To evaluate the application value of three-dimensional (3D) reconstruction at low-dose 128 slice spiral CT in diagnosis of central tracheobronchial diseases of children. Methods Written informed consent was obtained from parents of children. After multislice CT being performed on children with suspected central tracheobronchial diseases, the image data were reconstructed for 3D reconstruction images, then the observed results were compared with those of fibrobronchoscopy for further analysis. Results 55 children with suspected central tracheobronchial diseases were recruited, with the average age being 4 years old (1 month to 11 years old, 40 males). Among them, 47 cases were detected with tracheal bronchus abnormality by fibrobronchoscopy, and 8 cases with tracheobronchomalacia. The results of 3D reconstruction at low-dose 128 slice spiral CT showed that 43 case were true positive, 4 cases false negative, 1 case false positive and 7 cases true negative. There was no significant difference (P=0.486) between 3D reconstruction CT and fibrobronchoscopy in the diagnosis of central tracheobronchial diseases of children. The sensitivity and specificity of 3D reconstruction CT was 91.4% (43/47) and 87.5% (7/8), respectively, and the whole accuracy was 90.9%. Conclusion Low-dose 128 slice spiral CT shows high sensitivity and specificity in detecting central tracheobronchial disease of children, and has important application value in diagnosing central tracheobronchial disease of children.