Reflux related respiratory symptoms in children

ABSTRACT
Gastro-esophageal reflux (GER) is one of the most common gastrointestinal conditions in childhood, affecting infants, toddlers, and school-age children alike.
While regurgitation and vomiting are its most visible manifestations, a substantial proportion of children present with atypical or extra-esophageal symptoms that primarily involve the respiratory tract. The relationship between GER and conditions such as chronic cough, recurrent wheezing, recurrent pneumonia, laryngomalacia, brief resolved unexplained events, and even obstructive sleep apnea has been debated for decades. Two main mechanisms, vagal-mediated reflexes and direct microaspiration of gastric contents into the airways, are widely held to be responsible. Yet, establishing causality rather than coincidence remains a diagnostic challenge, particularly given the high prevalence of both GER and respiratory symptoms in young children. This opinion article critically examines the current evidence linking GER to respiratory manifestations, discusses the strengths and limitations of available diagnostic tools, and evaluates therapeutic strategies. We argue that a multidisciplinary approach, individualized clinical assessment, and cautious interpretation of pH-impedance findings are essential to avoid overdiagnosis and unnecessary pharmacotherapy. Clinicians must weigh the potential harms of empirical acid-suppressive therapy against the unproven benefit in respiratory endpoints.

KEY WORDS
Gastro-esophageal reflux; respiratory symptoms; children; microaspiration.

Received: Jul 15, 2026
Accepted: Aug 31, 2026
Published: Sept 11, 2026