Is REFLUX Causing Your Child’s Asthma?

What is Reflux?

Simply stated, reflux – or Gastro-esophageal reflux (GER) – is the regurgitation of gastric contents into the esophagus, or even higher, into the mouth or nose (lovely image, no?).

You see babies with reflux all the time. You know, babies “spitting up”. Gastro-esophageal reflux (GER) is common among infants, but it usually resolves on its own – it is estimated that 50% of 2-month-old infants have reflux of gastric contents (regurgitate, or “urp up”) at least twice per day, but only 1% of them still do it at 12 months old.

Most infants simply out-grow it. As they spend more time upright, they reflux less. For nearly all babies with reflux, it goes away without intervention. Most of these infants who are “spitty babies” do not seem bothered by this; most they don’t have symptoms.

So – for most babies with reflux – they don’t have symptoms, and it goes away by itself.

Groovy.

A small minority of babies will have symptoms from GER, and some do not outgrow it. When GER is abnormal, it gains the designation GERD: gastro-esophageal reflux disease.

One of the ways that reflux can show itself in babies, infants, and children is asthma. “Reactive airway disease.”

How Does Reflux Cause Asthma?

There are probably 2 mechanisms involved.

(1)  The first involves inflammation from the reflux. Reflux causes inflammation of the esophagus – esophagitis.

Various biochemicals from that inflammation cause a reaction in other parts of the aero-digestive system. See my article on the Unified Airway Model for more.

(2)  The second mechanism involves nerve reflexes that are triggered by the irritated esophagus – the esophagitis.

These reflexes cause bronchospasm – commonly known as asthma. There is evidence that both of these mechanisms contribute to reactive airway disease.

[Aside: although we are focused on asthma here, reflux can be a factor in rhinitis, sinusitis, otitis, and almost any “itis” of the upper airway – see future posts.]

Of course, what you want to know is:

Does MY Child Have Reflux ?

Two Common Tests:

Esophagoscopy

There are several ways to look for reflux, or to look for evidence of reflux.  One of the ways that we can tell that reflux is causing inflammation is to look at the esophagus – if there are inflammatory changes (esophagitis) then we consider the reflux to be a significant problem.

Back in one of the earlier studies looking for a link between respiratory symptoms and reflux, we asked, “what is the prevalence of reflux among infants and children with difficulty breathing?”

When we looked at the esophagus of infants and children who were taken to the operating room for airway evaluation (a group of children who had breathing difficulties, like severe asthma, stridor (squeaky breath sounds), apnea, recurrent pneumonias, so that endoscopy in the operating room was indicated), we found that 71% had reflux esophagitis!

That doesn’t prove that their reflux was the cause, but suggests a strong link between reflux esophagitis and breathing difficulties in babies and children.

pH Probe

Another way to look for reflux is to measure pH (acidity) of the esophagus over time using a pH probe – a long catheter placed through the nose into the esophagus, left in place at least 24 hours to record the pH (no, not a lot of fun).  When this has been done with infants and children, multiple studies have found that episodic stridor and apnea are correlated to gastric acid refluxing into the esophagus.

One limitation of using a pH probe to diagnose reflux is that some people (especially babies and children) have non-acid reflux.

That means that the pH probe will not detect the reflux (it isn’t acidic), even though they are refluxing, and even though the reflux is causing symptoms. A newer probe that can detect even non-acid reflux is the combination pH / impedance probe. Its use is similar to the usual pH probe, just as uncomfortable.

So, if your child has asthma, is there an easy way to tell whether reflux is a factor?

Treatment as a Diagnosis

Other studies have shown that episodes of reactive airway, asthma, and wheezing all correlate with reflux by pH probe;  ALL of these symptoms improved significantly after medical or surgical treatment of the reflux.

Treating children who have these breathing difficulties (for example, asthma, stridor, or apnea) for reflux can relieve their breathing symptoms.

One study found that 82% of asthmatics have reflux;  70% asthma improved by treating them for reflux.

Sounds promising, yes?

To conclude, perhaps the simplest way of finding out whether reflux is the cause of your child’s symptoms is this:  treat them as if they have reflux, see whether their symptoms improve.

Next week we will review the treatments for reflux – conventional and alternative approaches.

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I appreciate your comments and questions.  Keep ‘em coming.  Please, “be excellent to one another.”

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Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor :~D)

Resources (this blog):

Things You Should Know About Reflux: http://wp.me/pR4iB-7k

Things You Should Know About Asthma: http://wp.me/pR4iB-7b

What is the Unified Airway? http://wp.me/pR4iB-gS

Use Plants to Purify Your Air: http://wp.me/pR4iB-bs

Reflux and Otitis: Does GER Cause Ear Infections? http://wp.me/pR4iB-fZ

Stop Breathing: Your Air is Killing You (and what to do about it): http://wp.me/pR4iB-5E

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Comments

  1. Hi Dr. Russ, love your posts, as usual. So, we’ve talked about this before, that I just started treating my son for reflux after you mentioned the correlation between cough variant asthma and reflux to me.

    I do remember that he WAS still spitting up at 12 months old. And, it was when the spitting up finally did stop .. maybe about 15 months, that the cough variant asthma started.

    We have now started using DGL for him, and I give him a lot of enzymes and probiotics .. and he is doing so wonderful. thanks to you. thank you very much.

    One question. I’m about to take him to a chiropractor so he can test if he has a hiatal hernia that could be causing reflux. Do you have any thoughts on this? If he did have a hiatal hernia, would reflux treatments (like dgl) work on him?

    thanks, Lisa

    • Russell A. Faust, PhD, MD says:

      Hi Lisa,
      I really appreciate the follow up on how your son is doing, and thanks so much for your kind and encouraging comments! I have no experience with Chiropractic for hiatal hernia, or for reflux, but there is strong support for help from Chiropractic. Despite my own lack of experience with Chiropractic and reflux – if it helps, I fully support it!! Its all about the results: as long as a remedy does not add risk or hurt my patients, it’s all good.
      If you follow that path, please check back with us to let us know your results. That way we can all learn!
      Thanks for visiting, and please keep us posted.
      RF

  2. Tellyrow says:

    Hi Dr. Faust,

    I asked my son’s allergist about the possibility of reflux causing his coughing. His allergist didn’t think it was likely since my son wasn’t in any pain or discomfort when he applied a good deal of pressure to his stomach area. What are your thoughts on this? Could reflux still be a possibility without pain in the stomach area?

    Many thanks!

    • Russell A. Faust, PhD, MD says:

      Hi T,

      If it weren’t for the fact that we are talking about your son’s health, the response of your allergist would be funny.

      “Pushing on the abdomen” is not the test for reflux in a child (or in an adult, for that matter!).

      In fact, in children, reflux is often exhibited only as respiratory symptoms. Furthermore, the “gold standard” for diagnosing reflux is performing esophagoscopy (endoscopy of the esophagus) and taking small biopsies to look at under the microscope to look for evidence of reflux esophagitis. That is, under general anesthetic, they look into the esophagus (and usually the stomach also), take small biopsies, and send to the pathologist for a diagnosis. That’s the long and difficult route for a firm diagnosis.

      The simpler route is to ask questions about the patient’s clinical history: any coughing at night – especially if coughing is ever so severe that the child vomits, along with morning throat-clearing and morning cough, are indicators of gastro-esophageal reflux in a child. If that child has been diagnosed with “asthma,” and also has these symptoms, the suspicion of reflux is strong.

      Children simply do not have “heartburn,” and commonly do not complain of “stomach ache” related to reflux. Several ENT docs who are way smarter than me have been researching reflux in children for decades. As just one example, do a search for “Nancy Bauman reflux” to read more.

      With regard to diagnosis, I usually rely on my clinical history, and if I am sufficiently suspicious, will recommend an anti-reflux regimen as a trial. This may include the relatively safe anti-reflux medication, Ranitidine (Zantac). If the child’s symptoms improve after a two-month empiric trial of Zantac, I have confirmed my diagnosis. At that time, I often have the child seen by my gastroenterology and naturopath colleagues for further evaluation or treatment as indicated. I am simply not a GI doc. I include the naturopath doctor because they often find subtle issues with diet or nutrition or environment that can be managed for great benefit.

      I’m sorry that you are encountering such ignorance in the medical world. The really unfortunate thing is that, as a result of the extensive training that we docs go through, many of us believe that we have learned it all, that there is no more for us to learn; many of us simply lose our curiosity and lose our openness of mind.

      For me, I have learned the most from parents (mostly mothers) of children with chronic illness. They have been to many (too many) physicians, many specialists and “experts”, and – if their child is truly, chronically ill – they have begun to lose faith in “modern” medicine. The majority have therefore evaluated many “alternative” remedies, and have discovered on their own which ones benefit their child. I will say it again: I am grateful to those parents for continuing to educate me.

      I wish you success with your son, and in your search for trustworthy medical counsel and care.
      RF

      • Tellyrow says:

        Thank you, Dr. Faust! I didn’t think reflux was diagnosed by abdomen pushing either!

        My son coughs at night occasionally, but never so severe that it causes vomiting. I don’t even really know if he wakes himself up with his coughing! He does have morning throat-clearing (although, as of late, he’s been clearing his throat throughout the day as well) and yes, he has a morning cough too. He also tends to cough after he’s been running around or if he’s climbed a few flights of stairs. He passed a pulmonary function test with flying colours and I was told that he doesn’t have asthma. So if he doesn’t have asthma, why the coughing and all the throat clearing? My suspicion is reflux, but are there any other conditions I should be considering and asking my doctor about? Since he has non-allergic rhinitis, I’m often told that his coughing is due to post-nasal drip. But then I’m always wondering….what’s causing the non-allergic rhinitis???

        You mentioned that you typically use pharmaceuticals on a trial period to see if a child’s cough improves or not. Do you ever just try the natural alternatives first without going the pharmaceutical route?

        We have an appt next week with a pediatrician that specializes in respiratory conditions. Hopefully, he can provide as good advice as you! I sure wish we lived near you so I could bring my son to see you!

        • Russell A. Faust, PhD, MD says:

          Hi Again,
          I can’t recall your son’s age. In my experience (and in the experience of many allergists), many children that clearly have allergic rhinitis do not show allergies when they are tested. We have no idea why not, but this suggests that the mechanisms that indicate allergies when we test adults, are not the same mechanisms that are working in children.
          Regardless, reflux remains high on the list of suspicions.

          The reason that I will “test” my suspicion for reflux by prescribing Zantac for a couple months is that Zantac is relatively safe, benign, without much in the way of side-effects. Most of the natural alternatives for treating reflux have not been tested extensively in children. Their safety profile has not been established in children. I have also seen a wider variety of results in children with the natural remedies. I encourage using them once I have a diagnosis (and rely heavily on my naturopath colleagues for recommendations), but I have found that I can get to the answer more quickly if I simply prescribe Zantac for a couple months.

          Speaking of “natural” – please do read my opinion on the notion that all things natural are safe and healthy: they aren’t (http://www.boogordoctor.com/2010/06/a-few-words-about-being-natural/).

          Best success with you specialist next week. Please do keep us updated so that we can all learn! And thank you so much for your kind comments. I wish I could help more, too.

          RF

          • Hello,

            What brand of and from where do we get good form of DGL ? Sorry, I have seen Licorice in big stores like costco but not sure if i have seen one that said DGL licorice. Maybe, I didn’t pay too much attention then.

          • Russell A. Faust, PhD, MD says:

            Hi Dave,
            Good question. I had difficulty finding DGL at the usual places locally. They didn’t even know what I was talking about. But of course, Amazon has an amazing array, and I simply found one on Amazon that had decent reviews:
            http://goo.gl/nXaMX
            For some reason, ALL of the DGL are a chewable. Something about chewing it releases the DGL.
            Best success, and please let me know if you find a great source for DGL, or a great price!
            Thanks for visiting,
            RF

          • Hello Dr. RF,

            Thanks for the info on DGL. I had one other question: Are there any natural/herbal remedies for kids who throw up whitish/yellowish fluid in the morning ( bile ? ). Could there be a possible H-pylori factor and any sure shot way to find that out or treat it ? Not sure if this too is related to GER or if its a different kind of problem.

          • Russell A. Faust, PhD, MD says:

            Sorry, Dave, but I don’t have a recommendation for you, except to advise you to find a physician that you trust, and work with them for a solution.
            RF

  3. Question for you about my son…he is almost 3 years old and has food (peanut) and environmental allergies. He is doing a clinical trial for his peanut allergy, but everything is great with that and not related in any way that I can see to what I will describe here. He is on Nasonex and Zyrtec. This year, he has had three colds that have turned into nasty coughing and one instance of wheezing deep in the lungs. All three times, the only thing that helped was antibiotics…it cleared it up within 2 days of starting the z-pack. He had a lot of spitting up as a baby and there were times after he turned one. Also, often at night I will hear him smacking his mouth and then swallowing or rarely coughing. I don’t know if it is postnasal drip or reflux. We see our allergist again next week and our pediatrician gave us a prescription for Flovent. I haven’t started it yet though. Anyway, I don’t want him on more steroids if we can avoid it, but I also don’t want him to have to deal with the coughing issues again. Would reflux lead to an infection situation after a cold? What else should I bring up with the allergist? Should we see a pediatric ENT or pulmonologist or just stick with our allergist? Thanks for any suggestions you might have.

    • Russell A. Faust, PhD, MD says:

      Hi Lisa,
      I always recommend getting another opinion when you’re frustrated or struggling. A pediatric ENT or pulmonologist would be a good place to start. That age range is the most difficult to manage: they’re too small to cooperate, and too big to over-power without trauma. That makes it challenging to add nasal saline rinses to the treatment regimen. I recommend you take a look at the videos of young children doing nasal saline rinses on Nasopure.com – great resource!
      Sinusitis that clears while on antibiotics, but returns within 2 weeks once of the antibiotics, sounds suspicious for chronic infection – often the result of bacteria that produce “biofilm”. That is more challenging to cure, but is possible. Ask your allergist, and read the articles on this site.
      Please do keep us updated!
      Thanks, RF

      • Thanks! It only recurs after a cold, so the antibiotics do kick it completely. Then he has gotten another cold a few months later and it goes from normal cold to the nasty cough again and another round of antibiotics. We have the Nasopure, but he doesn’t get how to keep it out of his mouth, so he ends up gagging on it. But, we will keep trying.
        We will see our allergist on Tuesday to see if we can get to the bottom of it! Thanks.

        • Russell A. Faust, PhD, MD says:

          Hi Lisa,
          Be sure to watch the videos on Nasopure.com, if you have not already been there.
          I have found some success by having kids hold their breath while they are rinsing. This seems to prevent the gagging and choking issue, but not always.
          Best success, and thanks for the updates!
          RF

          • Visit with the allergist today. He said we should try Singulair before we looked at Flovent. So, we will try that. I know to watch out for behavior and sleep issues with that medication, but we will give it a try to see if we can stop the cycle of the antibiotics. I will also continue to try the rinses. As he gets older, I think that will be an easier option and we are already planning to do immunotherapy to see if we can get him off all these medications and healthier overall. ;).

          • Tried doing the nasal rinses with Nasopure and all the suggestions and he is having none of it! He scream when I even mention anything about it! So, we will stick with the Singulair for a bit and see if that helps keep his allergies in check and then when he is older and more mature, we can do the nasal rinses and move on to the immunotherapy. Thanks for all the information and the responses.

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Yes, I am also familiar with the drama of trying nasal saline rinses in a little one. Be sure to check Dr. Hana’s site (Nasopure.com) for some great videos of young children performing nasal rinses! However, if your little one is resistant like my own was, do what we did: simply use nasal saline SPRAY in a small bottle. We used (and still use) the saline spray that contains Xylitol from “Xlear.com” – pronounced “clear,” the Xylitol helps prevent infections. Also take a look on this site for articles about the benefits of Xylitol: http://www.boogordoctor.com/2011/06/a-story-about-a-sugar-the-x-factor/
            It helps that Xylitol is a naturally-occurring sugar that bacteria cannot metabolize, but it is sweet so kids love it. Our own monkeys LOVE the “Sparx” xylitol candies.
            Thanks for sharing, as always, and please let me know how it goes.
            RF

          • Thanks for the follow up! I will check into the Xlear product. Did you use the kid’s nasal spray and if so, when did you use it? My son also does Nasonex, so he is used to that sensation, so I assume that this works the same way, a squirt in each side of the nose. However, if we added this spray, should I do it at a different time than his Nasonex? I would assume so. He does the Nasonex in the morning and his Singular/Zyrtec at night before bed.
            Thanks again! I really appreciate your site and your Twitter information too!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            The “kids spray” is no different from the others from Xlear.
            My advice for the spray is to avoid the expensive (and potentially dangerous) glass containers if you are using for kids. We buy the small, cheaper plastic squeeze bottles of Xlear nasal spray. That way, each of our kids can carry their own bottle, use it whenever they like, and the bottles are safe from kid-abuse.
            If also using nasal steroid sprays (Nasonex, a good one for children), simply use the Xlear before the Nasonex so that you don’t wash away the Nasonex with the saline spray. Sounds like you have a reasonable regimen. Simply use the Xlear to keep things rinsed and clean with the saline spray, and also for the other benefits of the Xylitol.
            RF

          • I ordered the Xlear and have been using it once a day with him, prior to his Nasonex. I am not sure how much is getting in there with the plastic bottle? I might try the glass one later…for now, the elephant on the front is really helpful in getting the 3 year old to do yet another thing! We call it “elephant tickles” and his Nasonex has always been “nose tickles”. He is still doing the Flovent as well. I guess we will find out if any of this is helpful when his next cold hits. Keeping my fingers crossed! Happy Holidays!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            I like it … elephant tickles.
            Be sure that your little guy is also on a great probiotic. For my own three monkeys, the probiotic made the biggest difference in decreasing the frequency and severity of ‘colds’ – URI’s. Our results were much better than the clinical trial results that were published in the journal, Pediatrics. “Your mileage may vary,” but every kid – asthma or any other ailment – can benefit from fewer colds, right?
            Based on my research of the literature, and our own experience, I endorse Probiotic Pearls for Children, from Integrative Therapeutics.
            For complete transparency: I have NO financial or other arrangements with them! They are simply the best, with the highest amount of probiotic making it through the stomach acid intact. That’s important.
            Thank you for sharing, and please do keep us updated.
            And Happy Holidays to you, too!
            RF

        • Thanks! He get a probiotic as part of his multivitamin (this one – http://www.amazon.com/Rainbow-Light-MultiStars-Chewable-Tablets/dp/B000EEBWHM/ref=sr_1_2?s=hpc&ie=UTF8&qid=1355678678&sr=1-2&keywords=rainbow+light+stars), but I am not sure how great it is. It looks like the one you recommend is one that has to be swallowed. My son just turned 3 and I am not sure I want to attempt pill swallowing just yet! Is there another option that you might recommend as a chewable?
          Thanks!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Yes, the Probiotic Pearls for Children are “enteric coated” caps, so they need to be swallowed. Usually not a big deal, though. Started our little guy on them at 19 months. Although I wouldn’t recommend this, I actually had a couple women in my practice who were giving them to their infants while nursing: they would pop the “pearl” into the mouth just prior to nursing, and told me it always went down easily. Our little guy did well swallowing them until he was about 3 or so, then refused to swallow (automatic, reflexive chewing) for about 6 months; okay swallowing them again now.
            There are two considerations with probiotics: the combination of bacteria; and the number of them able to make it through the stomach acid alive so they can have their effect on the gut immune system. All of the liquids and powders that are marketed for children are virtually all killed by the stomach acid. The regular caps are slightly better. The enteric-coated preparations are best. If your little one won’t/can’t swallow the pearls, you do the best you can. Dr. Alan Greene (Stanford / Packard Children’s Hospital) has a list of probiotics that he recommends for children on his site. I also included it in my free, down-loadable PDF on Prebiotics, Synbiotics, and Probiotics on this boogordoctor site, at this link: http://bit.ly/dFi1q7

            Thanks again for visiting and sharing.
            Best success!
            RF

  4. Dear Dr. Faust,
    I am so happy to have found your website. Thank you so much for all the wonderful information which we failed to receive from countless other doctors our son has seen. Our 7 year old son has been suffering for the last 4 years from a severe cough. My son has food and environmental allergies. He was diagnosed with reflux after going through an upper GI test. It usually starts with a cold or changes in the weather. He produces a lot of mucous. He has a clearing cough that very fast turns into a severe cough that would not stop for 2 weeks. He would be put on antibiotics, prednilosone, nose sprays, allergy meds, nebulizer treatment. None of them help him during the attack. He was diagnosed with asthma 4 years ago and was on advair and ventolin as needed, but even with the asthma meds he would still get the cough every 2-3 months. He had an adnoidectomy after being seen by an ENT. He was negative to CF test. His antibody levels were good. Each time we do a breathing test his results are great. He never wheezes or has any trouble breathing. He is also on Prevacid for his reflux. We have seen countless of specialists who could not diagnose him. We recently moved to TX and are seeing a great pulmonologist. He put our son on an aggressive med treatment which includes preventative antibiotics, nose sprays, tussin, nebulizer treatments, Advair and the list goes on. He suggested that we might need to do a Bronchoscopy to see if he produces mucous in his lungs. During the cough episodes, my son is completely energetic, he usually does not have fever or any other symptoms other than the cough. He does not cough while exercising. We also started him on SLIT to treat his allergies. If my son does have reflux which contributes to the cough, is 4 month on Prevacid with no results is enough to conclude that he does not have reflux? We took him to a homeopathic dr, which did not help at all. This week we are seeing an Acupuncturist to see if that will help. Is there anything that we are missing? How else could we help our son-we are desperate… Any advice from you would be greatly appreciated. Your website had been a great resource for us. Again, thank you so much.

    • Russell A. Faust, PhD, MD says:

      Hi Sharon,
      Thank you for your kind comments. Readers like you (and your son) are the reason I keep this blog going.
      My clinical practice was eventually filled by kids like you son: asthma, chronic rhinitis, chronic sinusitis, chronic cough; some with ‘failure-to-thrive,’ reflux, and most of them without any clear reason – no clear etiology. Most have normal immune systems based on our testing (immunoglobulin levels). Some improve on anti-reflux medications, some don’t. These children have a CONSTELLATION of symptoms, with uncertain etiology. Many improve while they are on steroids or antibiotics – but we can’t keep them on steroids or antibiotics forever! These are frustrating patients – for the docs, for the parents, and for the children themselves.
      For children like these, I have a couple comments:
      – The first is that, when anyone suggests doing more testing, try to have them clarify exactly how the test results will change management. For example, when a pulmonologist or ENT doc suggests performing a bronchoscopy to “see whether he is producing too much mucus,” they should be able to tell you how the answer to that question is going to change treatment. If the answer is that he IS producing too much mucus, exactly how will that knowledge going to change what you DO? You may find that docs will suggest doing more testing mostly because everyone is frustrated that they can’t figure out what is causing the problem, but in reality, the test won’t change anything. Bottom line: Try to avoid more procedures or testing unless the result will change what you do.
      – The second comment is that many children that fit this description often have chronic rhinosinusitis, or some other CHRONIC infection. That may be the result of reflux and the altered microbiome that reflux causes. It may be the result of multiple courses of antibiotics; it may be the result of chronic steroid use. Who knows. But chronic infections often are caused by biofilm-forming bacteria. Biofilms are extremely difficult to eradicate. Once in their biofilm, bacteria are as much as 1000-times more resistant to antibiotics, and are nearly impervious to our immune cells!
      There are a couple mentions of biofilm in articles on this site, but you might consider searching “biofilm eradication” online and reading everything you can on the role of biofilm in chronic head and neck infections, and how to eliminate them.
      – Finally, you must have a trustworthy relationship with your son’s physician – a doc who listens, and who does not jump to the old standards of antibiotics or steroids as the solution. Someone who will consider evidence-based remedies that may help, regardless of the source of those remedies. Such docs, who practice Integrative Medicine (integrating the best evidence-based remedies from any source) are becoming more prevalent as patients insist on better healthcare. Take a look at the website for the American Board of Integrative Holistic Medicine (ABIHM.org/search-doctors) for how to find some of those docs [transparency: I am a Director on the ABIHM Board of Directors].
      Thank you again for visiting, and for sharing.
      Please keep us updated so that we can all learn.
      RF

  5. Just to add to the above comment. He has been diagnosed with sinusities after a CT scan. We are also doing the nasal rinses every day which seems to help him. We feel like we have no control over his post nasal drip , even with all the meds he is taking.

    • Sharon – right there with you! The cough is SO frustrating. When my son gets it, the only thing to clear it is with antibiotics. So, we are now on Flovent to see if with his next cold it will prevent it from settling and turning into an infection. If infection shows again, then we are going to look at the biofilm issues more closely. Good luck to us all!

      • Thanks Lisa for the support. My son just finished a round of a severe cough and he is now on round two. This time he actually has a low grade fever and feels sick. So far the cough is not as severe as the first round. We are trying to control it with the Advair and especially the Albuterol nebulizer treatment. I started giving my son Xlear nose spray yesterday and unfortunately he developed what seems to be an allergic reaction to it. We think it might be the grapefruit seed extract which is in it… All we know is that the pattern of him getting sick stays the same which is a cold/allergy triggers his nose and sinuses. He produces a lot of mucous which we can’t seem to control. He has a clearing cough which then turns into a really bad cough during the day and night. He would usually end up throwing up mucous a few times in the middle of the night. For us, non of the medications seems to relieve or help the cough. We are giving him probiotic and anything else that we think might help him. Very frustrating. We are looking into acupuncture which we will start when he feels better. Also as Dr. Faust recommended I contacted a pediatrician in our area who is practicing integrative medicine. We are hopeful we will be able to help our son soon. I wish you all the best with your son as well.

        • Ugh…hope you figure out something! My son is sick again, so we are trying the Flovent 2 times a day to see if that will work. We have been using the Xlear too. He does have the junky cough right away this time. For him, his cough progresses and seems to get better, then slam, hits hard again and he starts to feel bad…prior it is just a regular cold…no fever, etc. Anyway, once that second wave hits, then we have done antibiotics and on the 2nd day of that, his cough goes away and clears right up. So, I don’t know what the deal is. I guess our next step is to head to an ENT to see if they can figure out what is going on if the Flovent doesn’t keep it under control this time around. It is stressful for me because I just want him to be healthy and not have to deal with the cough so much, but he really doesn’t seem to care too much and it doesn’t keep him down! So, I just keep trying new things to get it under control and he goes with the flow. He will not let me do the nasal rinse with him though…at all! Anyway…good luck to us all!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Yeah, the really little ones are easy to rinse; the older ones can be negotiated with. It’s those 3-6-year-olds that are the biggest challenge. Too big to wrestle with, too young and stubborn to reason with. What worked best for us during that period was the nasal saline spray that contains Xylitol (from Xlear.com; we get ours from Amazon). The Xylitol makes it sweet without risking dental cavities, and that helped us to get the little guy to use it regularly. You can click through the booordoctor’s Amazon Store for Xlear products, or just search for them on Amazon directly.
            Best success,
            RF

  6. Hi Lisa R. and Sharon,

    When I read your comments, I could relate to so much of what you said. Dealing with the constant coughing and buckets of mucus is exhausting and so frustrating!

    May I ask you both what your son’s food and environmental allergens are? Is there any chance that your sons are consistently exposed to any of their allergens?

    Lisa R., you mentioned that your son was in a clinical peanut trial. Do you recall if your son was less symptomatic prior to participating in the trial? Sharon, what about the SLIT? Was your son also less symptomatic before SLIT?

    As for probiotics, my 8 year old son, Mike, is on Kirkman Pro-bio Gold: http://kirkmanlabs.com/ProductKirkman/186/1/Pro-BioGoldand-Hypoallergenic/. These can be taken out of the capsule and just added to food if your little one cannot swallow pills. (By the way, I have no affiliation with Kirkman.) We’ve never tried the Pearls recommended by Dr. Faust because of possible traces of dairy in that product. Mike is anaphylactic to dairy so we avoid it completely.

    Something that has helped my son’s cough a good deal is magnesium. Believe it or not, if I skip a day of Mike’s magnesium, he’s coughing again the following day – not alot, but still coughing a bit. You can just do a search for magnesium and asthma to learn more, but here’s one article written by Dr. Mark Sircus: http://drsircus.com/medicine/magnesium/magnesium-asthma. Dr. Carolyn Dean is also another magnesium expert with fantastic info. Magnesium really is an extremely important mineral that is needed for 100’s (maybe even 1000’s) of processes in our body, yet our modern day diet doesn’t provide much of it or our bodies don’t absorb it well because of gut issues. Another important thing to consider is that magnesium can be depleted by certain medications, such as fluoride containing medications – like Flovent – so the body’s requirements for magnesium would be even more. There are a few ways to administer magnesium that are child-friendly – oral and transdermally. Mike does both oral and transdermal magnesium. Transdermal is a great route because you can just put the magnesium in the bath and let your kids play in the bath. Going through your skin also bypasses the gastro-intestinal tract, which is especially important if there are digestive issues – and our kids more than likely have gut issues.

    Sharon, if you try the magnesium, I would especially recommend the transdermal route for your son because he is on a stomach acid suppressor. If there is insufficient stomach acid, he may have trouble absorbing minerals such as magnesium if he takes it orally. Vitamin B12 also comes to my mind as sufficient stomach acid is also required for vitamin B12 absorption and there is a connection between vitamin B12 deficiency, asthma and chronic coughing. Measuring B12 levels might be something you can discuss with your doctor. We’ve also dealt with some reflux as well. From my understanding, reflux is more often caused by not enough stomach acid, rather than too much stomach acid. So, we treated Mike’s reflux with apple cider vinegar. For more information about this, you can google “Dr. Jonathan Wright and stomach acid” or even “reflux and low stomach acid.”

    As for mucus, the nasal rinses have been very helpful for us. Mike’s been doing this since he was 3. But we’ve also been recently trying nebulized glutathione for his lungs, as mentioned in Dr. Sircus’ article above. Glutathione is an antioxidant and has anti-mucus properties. We see a naturopath for this and Mike’s lungs are very clear now. Here’s a link to a youtube video of a little girl nebulizing glutathione for a cough: http://www.youtube.com/watch?v=_Iv-PRqSN2k. (Again, I have no affiliation with the glutathione product that is mentioned in this video.)

    Sharon, I’d be interested to hear how acupuncture works for your son. I have a friend who tried it for her son’s asthma with some success. Please keep us posted.

    I’ll be writing some articles in the future for Dr. Faust’s site in regards to the gut-immune system connection and our experiences with supporting and healing the digestive tract to reduce overall inflammation. It’s definitely been a learning experience for us and we’re still learning!

    Hope you have a great holiday! Here’s to better health for all of us!

    Tasha

    • Thanks Tasha! My son only has coughing after a cold…not during any other time. He has peanut allergy and pollen/grass allergies. He has been in the clinical trial for about 20 months now, which does include a daily dose of peanut flour, but he has had that the whole time and never has had any issues, so I don’t think this is related to that. Also, he started the trial when he was 17 months old, so we don’t have a lot to compare it to! I also haven’t noticed any difference with this issue between when he was on a probiotic and not on the probiotic…so, I am not sure what is going on with him. I saw a huge reduction in his eczema when we first started the probiotics and they seemed to be pretty effective with that until he was around 2…then it seemed that there was no difference for him when he was on or off them.
      I would love to do the saline rinses, but he screams and fights it, so I don’t push it too much! He does great with all his other medication, including the Flovent that we are trying out, so, I don’t want to push him now on that. I will start it later though.
      I am still not sure exactly what is going on with my son. He does have the eczema and allergies, but his cough doesn’t fit the pattern of asthma. He only coughs during a cold and when he has gotten antibiotics, it has stopped the cough completely within 2-3 days of starting the antibiotics. So, I have no idea what is going on. Also, his cough is always junky and productive. I think that maybe he just is prone to infection for some reason? I am taking him to an ENT on January 2 to hopefully get another opinion and look at what might be causing the issue. Maybe he just keeps getting the same viruses! :)
      Happy Holidays!

      • Russell A. Faust, PhD, MD says:

        Hi Lisa,
        Do give the nasal saline SPRAY a try, the one with Xylitol. The fact that it’s sweet is a big help. My little guy fought it at first, then realized that it is sweet. Try spraying it on his tongue first so that he gets the idea. For my little guy, my routine was to spray his nose with the Xlear.com nasal spray before ever diaper change. That way the spray had a chance to move to the back of his nose and throat while he was lying down for the diaper change, so that he tasted the sweet. I look forward to Tasha’s reply too, I’m learning a lot from her and other readers like her! (like you!)
        Thanks again for sharing,
        RF

        • I have been trying the Xlear with him, but haven’t noticed a difference yet. He is in the middle of another episode, so we visited the ENT on Wednesday and got an Xray to see if his adenoids are enlarged and infected. He said his tonsils looked just fine and normal, but it could be his adenoids causing issues. So, we will head back to him again in 2 weeks. My son is on another Z-pack to see if it clears up the junky cough this time. So far, I have seen improvement with the antibiotic that we aren’t seeing with the Flovent option. It is just frustrating! I do know that I will definitely get him on allergy shots as soon as we finish up our peanut immunotherapy trial! I talked to him again today about doing the nasal rinses and he said he would try it again….so we shall see! I would feel a lot better if he was getting that in each day! Thanks for the forum to discuss and share here. :)

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Whenever I hear the history of recurrent or chronic sinusitis that is cleared by a course of antibiotics, but that recurs soon after completing the antibiotics, I suspect infection by one (or more) of the bacteria that make biofilm. Research has now demonstrated that most chronic infections are caused by biofilm-producing bacteria. Once they surround themselves by their biofilm extracellular matrix they are very tenacious, and challenging to get rid of. I have written about eliminating chronic rhino-sinusitis on this site, and also about biofilm.
            Let’s see what other readers have to say about your boy’s struggles.
            RF

          • Hi Lisa, Our son’s former ENT also told us that his tonsils were fine but his adenoid was very enlarge and that we should consider taking it out. After seeking a second opinion, we did end up having our son doing the Adenoid Ectomy. I can not say that we have seen a big improvement after the surgery. He was still getting sick as before. My brother and his wife, who live in Israel, were also recommended that their son would go through an Adenoid Ectomy, as his son was getting sick a lot and had a nasty cough as well. Since they heard my son surgery did not help so much they went to an Acupuncturist. They also changed their son’s diet and have seen a great deal of improvement. Each child is different and the proceedure might benefit your child. I just wanted to tell our story.
            Good luck with everything. I hope your son get to feel better soon.
            Sharon

          • Thanks Sharon! We will go back in a week to see what the results of the Xray were. The antibiotics worked to quiet the cough again this time, so I just feel like something else is going on and it isn’t asthma. I am trying the nasal rinse again, but he has a lot of trouble with it. He doesn’t understand to keep his mouth closed and when we do the rinse, he gags and spits and it all goes in his throat. He just turned 3 and I have shown him the videos and talked and had him make the CK sound to close off his throat, but it doesn’t seem to work. Poor guy! I have noticed though that after doing that or giving him his Xlear or his Nasonex, he coughs….so, post-nasal drip is involved here for sure. Anyway, we will keep trying and see if we can figure it out.

          • Had our follow up visit with the ENT again. He said the adenoids were slightly enlarged in the Xray, but not what he would call significant. He mentioned that it could be the biofilm issue, but that it is likely all tied back to his allergies too. So, we are going to continue with the allergy medications and see what comes up next. He said that if he continues to have infections, that an adenoidectomy might be the answer, but he didn’t recommend it now.
            So, we are kind of back to square one. I am stopping the Flovent though since that doesn’t seem to be affecting anything in terms of his health or the cough. So, we will stick with our Zyrtec and Nasonex and I am going to up the Xlear to twice a day. He just will not do the nasal rinses no matter what strategy I try…he just gags and coughs and sputters. I am also going to find a good probiotic and look at some other immune boosting options to see if we can just keep him healthy to begin with.
            If anyone has any other suggestions on what to try, just let me know! :) Thanks for the forum to discuss and for your medical experience and background Dr. Faust. It helps to hear some options to look into and follow up with our own doctors!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Sorry to hear that. Sounds like half the kids in my clinic: frustrating to diagnose, and a challenge to keep well.
            I agree that biofilm is a possibility. And although I know you are already trying some of these tips below, I include them for other readers, too.
            The things to consider for eliminating biofilm are not fun:
            – daily saline rinses
            – include Xylitol in those saline rinses
            – include Manuka honey in those saline rinses
            – consider a couple drops of baby shampoo in those rinses
            – consider adding a high-quality probiotic to daily regimen
            Be sure to watch the video in this post: http://www.boogordoctor.com/2012/09/nasal-saline-rinses-to-treat-sinusitis/ It can help with rinsing young children – the little girl in the video is 4!
            Yes, baby shampoo, really. Studies have shown that baby shampoo can cut through the biofilm so that you can rinse away those bacteria. HOWEVER, I warn you to only use a couple drops in 8 oz of rinse. I made the mistake of adding a few tablespoons (!!) of baby shampoo to my own rinse when trying to knock-down my own chronic sinusitis. Let me say that it burns like wasabi (Japanese horse radish).
            The daily probiotic made a huge difference for me, and for our kids. But be certain to read the article about probiotics here. Ninety percent of the probiotics sold for children are eliminated by stomach acid – that’s an expensive snack to go to waste! Try to find an enteric-coated probiotic. We use Probiotic Pearls for Children, by IntegrativeTherapeutics.
            Best success, and please keep us all updated!
            RF

          • Hi Lisa,
            I truly believe that the nose rinses are one of the most effective ways to prevent sinusitis. We’re lucky that my son had no problem doing it and is doing it on his own. His twin brother, who is very healthy, (knock on wood:)), hated the rinses but when he was stuffy he asked me to rinse his nose. He told me he does not like the whole process of the rinse but he loves the way it feels after. My 3 year old is the tough one. She is also a very healthy girl but needs to rinse her nose once in a while. The only time she agreed was when we bribed her :). She also refuses to do it now, but we keep introducing it to her, letting her watch her brothers do it. My husband is also hooked on the nose rinses as well. The kids cracks up when he does it-it is funny to watch:) Have you considered the Allergy Drops with your son?
            Hope he feels better soon!

          • Russell A. Faust, PhD, MD says:

            Sharon,
            Agreed!!
            Thanks for contributing!
            RF

          • Yes, I am sure it is helpful, but he really just can’t do it just yet. I am not able to make it work like they show in the videos either…it does not come out my other nostril like it shows everyone else doing. I have tried different ways with the Nasopure bottle, but I wasn’t successful in getting it to work correctly on me and I can understand how that rush of fluid going back in his nose and down his throat is not so fun! Anyway, for now, we are just going to focus on using the Xlear on him twice a day, I am going to add a more focused probiotic back in his diet and we will continue with Nasonex and Zyrtec. Oh, and I am doing the quecertin (not sure if that is the right spelling) too.
            Oh, and we aren’t doing any allergy shots just yet. He is in a clinical trial for treatment of his peanut allergy and that is our most pressing issue. If all goes well with that, he will wrap that up this spring and we can start immunotherapy for his environmental allergens after that. I just didn’t want to put too much on his immune system all at once! We are so blessed to be in the clinical trial and I just wanted to focus on making that successful! Also, I am not sure exactly what he is allergic to yet, but I am guessing tree pollen, grass and ragweed. He did test negative for dust mites. His allergies are controlled though….he doesn’t have issues until he gets a cold and I think his body just gets overwhelmed. So, I am going to try to focus on prevention and keeping him healthy otherwise and take it from there. Hopefully as he gets older, we can see some improvement in these areas too. :) He just turned 3 in December, so he is still a little guy!

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            I feel you pain. We went through this with out little guy when he during his 2’s-3’s (now approaching 5).
            You are doing all the right things. The best you can do is minimize what you think are the triggers.
            Note that, at this age, a “negative” allergy test does not mean much, so don’t dismiss something as a possible trigger if you suspect it, simply because it tested “negative” on allergy tests. That holds for skin testing and ‘blood testing’.
            Best,
            RF

          • Okay…so an update on our little guy….we are all recovering from the Flu – Type A! Ugh! The good news though is that he had the flu and while he did have a cough, it has cleared up for the most part without antibiotics! So, that is good news. Our pediatrician also had us test his blood for IgA and for vaccine titers. His bloodwork results came back and his IgA is fine, but his Hib and Prevnar levels were low. So, that could be contributing to the issue of him getting a sinus infection with every cold! So, we are going to give him booster shots for both and then test his blood again in 6 weeks to see if that makes a difference for him. Fingers crossed that this is the issue!
            I have an appointment with a pulmonologist for next week, but with this latest news, I think I will cancel that appointment, but keep it in my pocket in case we need it in the future. Anyway, hopefully the booster shots will help him out and we can get him on the allergy immunotherapy later this year to help lessen those. I will let you all know how it goes this spring.

          • Russell A. Faust, PhD, MD says:

            Hi Lisa,
            Interesting. Sounds like his IgA is not a problem, but that he has not mounted great responses to the HibVax and Prevnar vaccines. Yes, that can certainly explain some of his issues, especially if those low titres are reflective of his general immune responses, and not just limited to his response to those two vaccines. Regardless, the therapy will be symptomatic, as you are doing. Keep up the good work, and thanks for sharing!
            RF

    • Hi Tasha,
      Happy New Year! Thank you for all the suggestions and information you posted. My Son started SLIT at the end of September. I think it is too early to know if they are working as it takes about 6-9 month for them to really take effect (as I been told by our Allergist). We were suppose to go to an Acupancturist , but my son got sick… This time it was beginning stages of Pneumonia. My worried was that I could hear the crackling sound that Pneumonia makes but also a squeaking sound that was not clearing. We took him to the Pulmonologist who said that my son is Hypersecritive, which means he is making too much mucous. That mucous instead of coming out with cough, stays. We ended nebulizing him every 3 hours with baking Soda and Levabuterol and also Ipratropium Bromide. In between treatment we had to tap his back to release the mucous. Right now he is doing much better. The junky cough we had from the Pneumonia turned into his “regular” clearing cough. Other than that he is doing very well. I also contacted, (as Dr Faust recommended), a Pediatrician who is also certified from the American Board of Integrative Holistic Medicine, and we are working with him as well.
      As for the Acupuncture. My brother ,who lives in Israel, took his son to one, and he said he has seen a great deal of improvement with his son’s coughing and getting sick. Tasha, I read your post about your son Eczema. What else is he suffering from ? Is he doing better on all the treatments you have mentioned?
      Wishing everyone a Healthy and Happy New Year!
      Sharon

      • Russell A. Faust, PhD, MD says:

        Hi Sharon,
        I have seen some great improvements in my own asthma patients with acupuncture.
        Take a look at a couple articles here by Robin Green: Acupuncture for Asthma. She has a Masters Degree in Traditional Chinese Medicine, and is a Licensed Acupuncturist.
        Thank you for sharing. Please do keep us updated on how things go with SLIT. I am very optimistic!
        RF

        • We know Eli has many food allergies which he was tested for. We just had a basic food allergy blood test done on him. They came back showing significant allergy to wheat and corn . Eli has been eating both without showing any signs of allergic reaction to either of these foods. Going back to his skin allergy testing I did not see that he was tested for wheat and the corn was very mild. My question is, how reliable are the blood test? Also, even though he is not showing any typical allergic reaction to wheat, could it be that his cough and hypersecretion is due to the wheat allergy? I did not discuss the results with his doctor yet because we are waiting for the rest of his tests to come in. I’m just very confused. Would love to hear your thought on that.
          Thank you,
          Sharon

          • Russell A. Faust, PhD, MD says:

            Hi Sharon,
            The younger the child, the greater the risk that allergy testing – both skin and blood – will be inaccurate. Even in children who appear to be classic clinical presentations of allergies, the younger ones often test “negative.” That can be frustrating, but allergy testing accuracy can be like flipping a coin in a child. Better to focus on clinical history and symptoms, look for triggers to avoid, and do everything possible to eliminate triggers and reduce symptoms to optimize quality of life.
            Be sure to take look at Dr. Janice Joneja’s site (http://www.allergynutrition.com/) for some great, useful information. Be sure to track down her background story on the site for a fascinating and inspiring read.
            And keep us updated.
            Thanks,
            RF

          • Thank you for the fascinating website! An excellent resource to actually understand the different allergy test and their results. Also thank you for your advice. Your website is amazing! Sharon

          • Russell A. Faust, PhD, MD says:

            Wow, Sharon,
            I’m blushing!
            It’s comments like yours that make it worthwhile for me.
            Thank you so much,
            Russ

          • Hi Dr. Faust. Thank you for the latest articles you posted. My husband will definitely try the Natural Sore Throat Remedy, as he gets them often. I wanted to ask you for your opinion on the You Know peanut test kits. My son is allergic to peanuts. It was confirmed in a skin test and blood test. It sounds like that the test will let us know if there is a chance my son will be able to have peanuts or will let us know that he will always have the peanut allergy, and can never eat peanuts. Another test he would like to do is a stool analysis which he said can give him a lot of information about the digestive system and allergies. My son is doing very well right now (knock wood). Even is clearing cough is not as frequent as it use to be. He is still on the Asthma inhaler and nose sprays. We are hopeful that he will continue this way:) Have a great weekend and thank you!
            Sharon

          • Russell A. Faust, PhD, MD says:

            Hi Sharon,
            You are very welcome!
            And as always, thank you for your kind comments, for reading, and especially for sharing.
            I have no experience with the uKnow Molecular Peanut Test, but I do note that a number of respectable allergy clinics are now offering it. I don’t know whether they are “incentivized” by financial factors. I can’t find much in the scientific literature about the test, but perhaps I’m not searching the correct terms. The test is “owned” by Thermo Fisher Scientific, a large and respected company in the bio-sciences, but I cannot find any clinical trial data on their site.
            If you learn more, please share!
            Thanks,
            RF

  7. Hi, my 2 1/2 yr old twin girl has just been diagnosed with reflux she had already been diagnosed with asthma several months ago. I am concerned as every 2 weeks she is having an attack almost to the day she has to go hospital as she gets partial lung collapse and at one time was in ICU with suspected pneumonia. I am terrified that next time her airways may give up. She has been tested for cf and this was negative she also had camera down throat to look in between bouts and airways looked great Dr said. I just don’t know if Dr’s are doing all they can as when I looked at statistics the state I live in in Australia has the highest deaths from asthma. She has had a new stronger asthma preventer a few days now and been on reflux medicine just over a week. But it bothers me as she still recently been in hospital with breathing and lung problems and I keep thinking surely the new medicines would have worked a little even enough to keep her well extra couple of days but she still every 2 weeks exactly I am terrified of what may happen in a week and a half when it time again.. She is seeing a fly in specialist today but I wonder is there something rare that she may have that they have not tested for…. Your opinion would be appreciated….. She is above average on growth and development….

    • Russell A. Faust, PhD, MD says:

      Hi Anna,
      My opinion? It will be important for you to find a knowledgeable, competent doc who will listen and connect with you and your daughter. That’s simple, but not necessarily easy. You need a doc who has seen and examined your daughter, who is familiar with her history, that you can call when you are anxious about her condition. A children’s hospital would be ideal, of course, but we can’t all have the luxury of convenient access to a children’s specialty hospital.
      My overall strategy for children like this is to have them allergy tested. If allergies are identified (usually not), then at least allergy immuno-therapy is an option to help decrease asthma triggers. Consider keeping a log book of her diet, activities, and environment. If you are fortunate you will be able to identify some triggers. If that is the case, do everything possible to eliminate those triggers from her environment.
      Lastly, maximize anti-inflammatory supplements: there are Quercetin/Bromolain tabs available for children. We use these for our three kids: http://astore.amazon.com/asktheboogodo-20/detail/B000M5PVAM (affiliate link). We also use nasal saline spray that contains Xylitol (another affiliate link: http://astore.amazon.com/asktheboogodo-20/detail/B000CL4MEC). The saline helps rinse out any allergens or pollutant particles that may result in infection or inflammation, and the Xylitol helps kill bacteria that cause sinusitis – another potential asthma trigger.
      Thank you for visiting and for sharing.
      Please keep me updated!

  8. how to prevent acid reflux symptoms says:

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