Reflux in Children: When It’s Not Asthma

Reflux in children is more common than many parents realize. While reflux in infants is often easy to recognize, older children may experience a different form—respiratory reflux—which can go unnoticed and undiagnosed.

Unlike the well-known reflux called GERD, which causes heartburn or stomach discomfort, respiratory reflux is more common and can lead to chronic breathing problems, hoarseness, and often mistaken diagnoses.

In this article, we’ll focus on reflux in children—not infants—and what parents should know to recognize the signs, especially when they mimic conditions like asthma.

Common Reflux Symptoms in Children

Reflux in older children can be difficult to recognize. Children don’t always describe their symptoms clearly, and reflux in kids often looks different than it does in adults. They may not mention heartburn or a lump in the throat, but they may show other signs that something is off.

Some common symptoms of reflux include:

• Persistent or excessive hoarseness
• Noisy breathing—especially on inhalation
• Chronic cough (particularly at night or after eating)
• Complaints of gas, bloating, or bellyaches
• Frequent burping or bad taste in the mouth upon waking
• Postnasal drip and frequent throat clearing
• Hoarseness, especially a rough, raspy voice
• Sleep disturbances or waking up coughing

If these signs are present, especially in combination, reflux may be affecting more than just your child’s digestive tract—it may be irritating the throat, vocal cords, and airways.

Reflux v. Asthma in Children: How to Tell the Difference

One of the most important messages for parents is that not all breathing problems are asthma. In fact, many people diagnosed with asthma may actually have respiratory reflux. This misdiagnosis is common, and my clinical experience suggests that as many as 80% of children labeled with asthma may actually have reflux-related airway symptoms instead.

The key difference lies in how the child is struggling to breathe.

Breathing Difficulties with Asthma

Asthma is a condition that affects the lower airways inside the chest and makes it difficult to breathe out. During an asthma episode, a child may:

• Wheeze, feel tightness in the chest, or have a noticeably prolonged or strained exhalation
• Lean forward, trying to push the air out
• Make a whistling sound while exhaling

Children with true asthma usually respond to inhalers or asthma medications.

Breathing Difficulties with Reflux

In contrast, respiratory reflux irritates and inflames the upper airway—particularly the throat and/or vocal cords. This can make it difficult to breathe in, as swelling or muscle spasms in the throat and/or vocal cords can restrict airflow. A child with reflux may:

• Appear to gasp or choke suddenly, especially after eating or while lying down
• Produce noisy breathing on inhalation or have a raspy, hoarse voice
• Experience sudden coughing fits, also sometimes with choking

These children don’t usually improve with asthma medications, and their episodes are often triggered by meals rather than exercise or allergens.

If you’re unsure, pay close attention to whether your child is struggling to get air out or to pull air in. Trouble breathing out suggests asthma. Trouble breathing in—especially when paired with voice changes or coughing after meals—may point to reflux.

The Importance of an Accurate Reflux Diagnosis

Treating a child for asthma when reflux is the real issue can delay effective treatment and allow the airway irritation to continue. Over time, this can lead to:

• Chronic inflammation in the throat and vocal cords
• Difficulty sleeping and poor daytime focus
• Overuse of unnecessary medications

By identifying reflux early, parents can help their children feel better—and avoid long-term complications.

How to Manage Reflux in Children Without Medication

Many families prefer to manage reflux without long-term medication, especially in children. Here are helpful tips to get started:

• Avoid acidic, high-fat, processed, and fried foods
• Choose low-sugar, high-fiber breakfast options like oatmeal or plain yogurt with non-acidic fruit
• Encourage your child to drink water rather than juice or soda to avoid high-sugar, acidic, and carbonated beverages
• Make sure your child eats before school or sports to avoid processed snack foods
• Focus on whole, unprocessed snacks that align with a reflux-friendly diet
• Don’t let your child go for long periods without eating, then have overly large meals, especially too close to bedtime
• Offer dinner at least three hours before bedtime to support digestion before lying down
• Encourage your child to eat slowly, chew thoroughly, and sit down for meals without distractions
• Keep portion sizes moderate, especially in the evening
• Include gentle, alkaline foods like rice, bananas, melons, or steamed vegetables as part of daily meals

Simple changes to diet and mealtime habits can make a meaningful difference in reducing reflux symptoms.

Final Thoughts on Childhood Reflux

Reflux in children doesn’t always look the way we expect. It can present without heartburn, mimic asthma, and lead to chronic symptoms that are easily overlooked or misdiagnosed. The good news is that, once recognized, it can often be managed effectively with simple dietary and lifestyle adjustments.

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For more information about diagnosis and treatment of acid reflux, see two companion books on Amazon: Dr. Koufman’s Acid Reflux Diet and Dropping Acid: The Reflux Diet Cookbook & Cure. If you would like to receive personalized guidance and strategies for lasting relief, consider scheduling an online consultation.