Silent Reflux In Babies: What Parents Need To Know

Silent reflux is reflux without the spitting up. Often, it’s nothing to worry about, but in some cases, baby will need to see the doctor. Here’s what parents need to know about silent reflux, including symptoms to look out for, tips for relief, and when to seek medical attention.

Reflux, when baby spits up breastmilk or formula contently, is completely normal for babies. It happens because the muscle at the bottom of their esophagus isn’t yet fully developed, so their stomach contents flow back into their esophagus and out of their mouth.

But sometimes, reflux can be more serious and cause baby pain.

If baby vomits often, and is in distress instead of spitting up happily, it’s fairly easy to tell that they need assistance. They may have the more serious GERD --- gastroesophageal reflux disease --- or another condition where they need medical attention.

Other times, though, babies will seem uncomfortable, but not spit up at all. Parents might think that baby’s distress is connected to something else. But baby could have something called silent reflux, where reflux happens without the spitting up. Here’s what parents need to know about silent reflux, including symptoms to look out for and when to seek medical attention.

What is silent reflux?

Silent reflux is another name for laryngopharyngeal reflux (LPR). This type of reflux is different from both normal reflux and GERD, although someone can have silent reflux and GERD.

When a baby has silent reflux, the contents of their stomach flow back up into their esophagus. Just like with the standard kind of reflux, this happens because their esophageal sphincter --- the muscle between their esophagus and stomach --- isn’t developed enough to keep their stomach contents in their stomach.

But unlike standard reflux, a baby with silent reflux doesn’t spit up the stomach contents that flow back into their esophagus. Instead, these contents often flow into baby’s nasal passages, the back of their throat, and their larynx (voice box), and then may go back into baby’s stomach.

For more on silent reflux, watch this video from Dr. Christian Fludder:

Why are babies prone to reflux?

Whether it’s silent or more traditional, younger babies are more prone to reflux because their esophageal sphincter hasn’t fully developed. They’re also consuming liquid food, which more easily flows out of the stomach.

And it doesn’t help that younger babies lie on their backs more, making them more prone to having their stomach contents escape. After all, when they aren’t upright, gravity can’t help keep their stomach contents down.

As baby gets older, starts to eat solids, and spends more time upright, and as their esophageal sphincter matures enough to stop the stomach contents from flowing out, they’ll usually be less prone to reflux. This almost always happens within the first year of life, and commonly occurs around the six-month mark.

Most babies will grow out of reflux on their own.This is also true of silent reflux. Many babies with silent reflux will still thrive, and silent reflux doesn’t always cause pain or distress.

But if silent reflux causes pain and negatively affects baby’s quality of life, consult your pediatrician. Don’t wait for baby to grow out of it if they’re in distress. Pain and distress while exhibiting silent reflux symptoms may be a sign of the more serious GERD.

Symptoms of silent reflux

It may be difficult to trace baby’s symptoms to reflux when they don’t spit up.

Look for these symptoms that may indicate your baby has silent reflux:

  • Gagging
  • Choking
  • Irritability
  • Swallowing after a feed, when there normally wouldn’t be milk or formula to swallow
  • Colicky crying (this is crying that you can’t console; there could be other reasons for the crying, though, if it isn’t accompanied by other silent reflux symptoms)
  • Noisy breathing or wheezing
  • Pauses in breathing (apnea)
  • Other trouble breathing
  • Trouble sleeping
  • Nasal congestion
  • Arching of the back during feedings
  • Chronic cough
  • Chronic respiratory conditions
  • Ear infections
  • Trouble feeding or refusal to eat
  • Hoarse-sounding cry
  • Failure to maintain or gain weight (although many babies with silent reflux will still maintain or gain weight, despite being in pain from other symptoms)

How to help reduce silent reflux?

The same strategies that work to reduce any reflux work to help reduce silent reflux.

  • Feed baby smaller amounts of food at each feeding, but on a more frequent schedule. Try to feed baby every 2-3 hours.
  • Burp baby several times during feeding (after every ounce or two), and then again after a feeding. This minimizes the discomfort that builds up from gastric pressure.
  • Keep baby upright during feedings, and for at least 30 minutes after feedings. Don’t put baby down to sleep --- or on their back or tummy to play --- immediately after a feeding.
  • Don’t bounce or actively play with baby for around 20-30 minutes after a feed. Keep them still and upright instead.
  • Don’t overfeed baby. Stop a feed when they show signs of fullness (like turning away from the breast or bottle).
  • If you bottle-feed your baby, choose a bottle with an anti-colic valve and a slower flow, to reduce the amount of air that baby takes in during feeding.
  • If you’re breastfeeding and experiencing engorgement, the hardness of your breasts may make it more difficult for baby to latch and lead to them swallowing air. To remedy this, soften the areola by hand-expressing some milk or pumping on a low setting, so baby can latch more effectively.
  • If you’re breastfeeding and suspect you have a strong let-down reflex, pump before nursing to slow down the feed, so baby doesn’t swallow as much air.
  • Remember that time is often the best medicine. Often, silent reflux will clear up on its own as baby’s digestive system matures.

A note on sleeping and silent reflux

Your baby should always be put to sleep on their back, even if they have silent reflux. Putting baby to sleep on their stomach or side increases their risk of sudden infant death syndrome. Also, as the American Academy of Pediatrics (AAP) warns, you should never elevate the head of baby’s crib in an attempt to relieve silent reflux. This may cause baby to roll into a position that could cause serious breathing complications.

When to see a doctor about silent reflux?

If baby experiences any of these symptoms from silent reflux, they’ll need immediate medical attention:

  • Any difficulty breathing, including apnea or wheezing
  • Persistent, chronic coughing
  • Refusal to eat
  • Failure to maintain or gain weight
  • Visible distress or appearance of being in pain
  • Choking

These are signs that baby’s reflux is more serious (and falls under GERD).

Remember, though, that most babies will grow out of their silent reflux in a timely manner. Severe silent reflux isn’t common.

But if you suspect silent reflux based on any symptoms, and you are concerned about how baby is coping, it’s best to talk to your doctor. They’ll be able to tell you if there are ways that you can manage baby’s silent reflux at home, or if they need other medical help.

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