Air pollution in households is a prime contributor to health issues in developing countries, as in the case of India. According to the latest National Family Health Survey Report 2022, more than half of India’s rural population and 41 per cent overall still depend on solid or unclean fuel combustions, which may reflect in future health hazards. Thus, it is crucial to understand the issue empirically. To that end, the study traces the transitional pattern of unclean cooking fuel users towards clean fuel over the last 30 years using responses from all five National Family Health Survey rounds. Further, the study uses an adjusted probit model to analyse the determinants that lead to the choice of cooking fuel in a household and a logistic model to examine the association between the choice made and the respiratory health of children under five. The empirical results show that the number of households using unclean fuel has declined over the years, with a slightly higher decline in the last five years. Moreover, it also shows that poverty status and place of residence significantly influence cooking fuel choice. Additionally, children residing in households that use clean fuels are less likely to suffer respiratory infections. In conclusion, the present study provides strong evidence to ameliorate the existing policies in a way that exhorts clean energy use. The authors propose pro-poor, pro-rural policies to expedite the clean energy transition, benefitting the most vulnerable households.