Acid reflux, or gastroesophageal reflux disease, involves the movement of stomach contents upward and into the esophagus. In addition to other symptoms, the disease causes coughing at night. Acid reflux causes as many as one-quarter of all cases of chronic cough, and cough is sometimes the only symptom of acid reflux, especially in toddlers and children.
Reflux and Coughing Connection
Coughing is the body's protective mechanism to protect itself from choking and aspirating. The cough associated with acid reflux, sometimes called reflux cough, occurs when acid from the stomach irritates the esophagus and lungs' lining. The irritation triggers the body to cough in an attempt to expel the irritant. Most adults with reflux cough experience an improvement in cough at night because the valve that works to hold stomach acid down remains closed during sleep. In toddlers, however, the opposite may be true. Infants and young children tend to experience a worsening of symptoms when lying down.
Other Reflux Symptoms
Although cough is sometimes the only symptom in toddlers with acid reflux, in many cases, other symptoms offer clues to a diagnosis. Heartburn is the most common symptom, but wet burps, spitting up, failure to gain weight, frequent vomiting, wheezing, irritability after eating and refusal to eat are other symptoms of acid reflux in toddlers. Symptoms in young children are usually worse when the child lies down, especially soon after eating.
Treatment
Most causes of acid reflux and coughing at night in toddlers are treated with antacids or prescription medications, including proton-pump inhibitors and H2 antagonists, to decrease stomach acid production. Dietary changes to eliminate spicy foods, citrus, chocolate and other offensive items may be necessary. Mild acid reflux may be treatable with home remedies like sleeping semi-upright and eating smaller meal portions, and with over-the-counter medications.
Considerations
Any toddler with a night cough requires medical evaluation to rule out other causes of the symptom. Asthma can cause toddlers to cough during sleep, and this disease is potentially fatal without treatment. Any cough that persists longer than eight weeks requires chest X-rays to rule out pneumonia, allergy testing to check for allergic causes, and a full medical evaluation to rule out asthma and other medical conditions.
