All About Silent Reflux in Babies: a Concise Guide for Parents

Anybody has encountered babies suffering from reflux? Or silent reflux? Was any medication given? My poor baby boy at 1-month-old is so unhappy all the time and crying. – Mum from our TAP Community.

If you are a parent of a baby with reflux, you know the agony it brings, with quite obvious signs. But what if your little one has silent reflux? Do you know about the symptoms of silent reflux baby might be suffering from? 

Let’s find out more about this topic not many parents know too much about. 

Reflux in Babies 

In young babies, reflux occurs when food backs up (refluxes) from their tummy. This causes them to spit up or vomit. 

Reflux in babies is also known as gastroesophageal reflux (GER). It happens because, in young babies, the small ring of muscle between the stomach and the oesophagus is not mature and not fully functional yet.

In other words, think of it like a valve that doesn’t close properly. When it doesn’t shut properly, the stomach’s contents flow backwards and out. You will notice this as spit-up or vomit. It’s made extra uncomfortable by the fact that stomach acid might also come up and out with the milk. 

It doesn’t help that your baby is on a liquid diet of only milk, or that they are flat on their backs most of the time — these factors all contribute to infant reflux.

The good news is that usually, reflux disappears by the time your baby is around 18 months old. This is because soon enough, the muscle between the stomach and oesophagus will mature.

When this happens,  it remains closed at all times except when your baby swallows, making sure the stomach contents do not come out. 

Reflux vs Silent Reflux in Baby – What’s the Difference?

Many parents are familiar with the concept of reflux, where babies spit up milk or formula after feeding. However, there’s another condition called silent reflux that may go unnoticed. So, what’s the difference between the two, you ask.

Reflux, also known as gastroesophageal reflux (GER), is a common condition in babies where the contents of the stomach, including milk or formula, flow back into the oesophagus. This can cause spitting up, regurgitation, or vomiting after feeding.

Silent reflux, also referred to as laryngopharyngeal reflux (LPR), is similar to reflux but with a key difference. Instead of the stomach contents being expelled through the mouth, they reach up to the throat, voice box, or even the nasal passages. This type of reflux is called “silent” because it doesn’t always lead to visible spit-up or vomiting, making it harder to diagnose.

Let’s take a look at this table:

4 Signs of Silent Reflux in Baby

Remember, this condition makes it harder for you to know if your child is indeed suffering from reflux. However, here are some signs that can help you pinpoint silent reflux in your baby:

1. Chronic Coughing: If you notice that your baby has a persistent cough that doesn’t seem to go away, it could be a sign of silent reflux. Silent reflux can cause irritation in the airways, leading to a chronic cough.

2. Wheezing: Wheezing is another potential indicator of silent reflux in infants. If your baby makes a high-pitched or whistling sound while breathing, it’s worth considering silent reflux as a possible cause.

3. Hoarseness: Silent reflux can cause inflammation in the throat and vocal cords, resulting in hoarseness or a raspy voice in your baby. If your little one’s voice sounds strained or different, it might be a sign of silent reflux.

4. Difficulty Swallowing: Babies with silent reflux may exhibit difficulty swallowing or seem to struggle when feeding. They may gag, choke, or show discomfort during feedings, as swallowing becomes a challenge due to the refluxed stomach contents.

5. Frequent Throat Clearing: Constant throat clearing or a repetitive “hmm” sound can be indicative of silent reflux. Your baby may make these noises as a way to relieve the discomfort caused by refluxed acid irritating the throat.

6. Recurrent Ear Infections: Silent reflux has been associated with recurrent ear infections in babies. The refluxed stomach contents can travel up the throat and into the Eustachian tubes, leading to inflammation and increased susceptibility to ear infections.

If you suspect that your baby has silent reflux based on these signs, it’s important to consult with a healthcare professional for a proper diagnosis and appropriate management.

Complications of Silent Reflux in Babies

While silent reflux may not exhibit typical symptoms like spitting up, it can still cause problems and impact a baby’s well-being. Below are some of the possible complications that can occur in babies with silent reflux:

• Recurrent Respiratory Infections

Silent reflux can increase the risk of recurrent respiratory infections in babies. The refluxed stomach acid can irritate the airways, making them more susceptible to infections such as bronchitis or pneumonia.

• Aspiration Pneumonia

When refluxed stomach contents are accidentally inhaled into the lungs, it can lead to aspiration pneumonia. This condition occurs when the lungs become inflamed or infected due to the presence of foreign substances.

• Poor Weight Gain

Babies with silent reflux may experience feeding difficulties, which can contribute to inadequate weight gain or even weight loss. The discomfort associated with reflux may cause babies to eat less or refuse feeds, affecting their growth and development.

• Feeding Difficulties

Silent reflux can make feeding a challenging and unpleasant experience for babies. The discomfort and pain from reflux episodes may lead to fussiness, crying during feeds, or frequent interruptions, making it difficult for babies to obtain adequate nutrition.

• Esophagitis

The repeated exposure of the oesophagus to stomach acid can cause inflammation and damage to its lining, a condition known as esophagitis. This can result in discomfort, pain, and difficulty swallowing for babies with silent reflux.

• Sleep Disturbances

Silent reflux can disrupt a baby’s sleep patterns. The discomfort caused by reflux episodes, especially when lying down, can lead to frequent waking, restlessness, and overall poor sleep quality.

It is important to remember that each baby’s experience with silent reflux can vary, and not all babies will experience these complications.

In rare cases, silent reflux in babies may cause,

• Narrowing of the area below the vocal cords

• Contact ulcers

• Recurrent ear infections 

• Buildup of middle ear fluid

When Will My Baby Outgrow Silent Reflux

In general, reflux — silent or otherwise — will clear up on its own by the time your baby is around 18 months old. 

But if it doesn’t (and you notice the symptoms of silent reflux baby will experience, as listed above), there it’s best to head to the doctor. 

How to Diagnose Silent Reflux in Babies

Diagnosing silent reflux in babies typically involves a comprehensive approach to evaluate their symptoms and assess the extent of the condition. Healthcare professionals employ various tests and examinations to reach an accurate diagnosis. These may include symptom evaluation, physical examination, pH monitoring, and endoscopy.

Symptom evaluation involves assessing the baby’s feeding patterns, behaviour, and any signs of discomfort. During a physical examination, the healthcare provider may check for indicators such as throat redness, inflammation, or swollen vocal cords.

pH monitoring measures the acidity levels in the baby’s oesophagus over a certain period to identify abnormal reflux patterns. In more complex cases, an endoscopy may be performed, where a small, flexible tube with a camera is inserted through the baby’s mouth to visually examine the throat and oesophagus.

These diagnostic tools aid healthcare professionals in accurately diagnosing silent reflux in babies, enabling them to recommend appropriate treatment strategies.

Treatment Options for Silent Reflux in Baby

Silent reflux can be challenging for babies and their caregivers. The good news is that there are effective treatment options available to manage it. Here are some commonly used treatments that can help alleviate the discomfort and symptoms associated with silent reflux in your baby:

• Feeding Changes

Modifying the feeding routine can make a significant difference for babies with silent reflux. This may involve smaller, more frequent feedings to prevent overfilling the stomach and triggering reflux episodes. Some babies may benefit from thicker feeds, achieved by adding a small amount of rice cereal to the milk or formula.

• Upright Positioning

Keeping the baby in an upright position during and after feeding can help reduce reflux episodes. Holding the baby upright for at least 30 minutes after each feeding can help gravity keep the stomach contents down, minimizing the likelihood of reflux.

• Medication

In certain cases, medication may be prescribed to manage silent reflux symptoms. Proton pump inhibitors (PPIs) and histamine-2 receptor blockers (H2 blockers) are commonly used to reduce stomach acid production and alleviate symptoms. However, medication should only be used under the guidance of a healthcare professional.

• Thickening Feeds

Thickening feeds with commercial thickening agents or natural thickeners can help reduce the likelihood of reflux episodes. This can be particularly useful for babies who struggle with frequent regurgitation.

• Consultation with a Specialist

In severe or persistent cases, consulting with a pediatric gastroenterologist or other specialists may be necessary. These specialists can provide further evaluation, guidance, and recommend additional treatment options if needed.

How to Prevent Reflux in Babies

No parent wants their baby to experience reflux, silent or not. And while it’s normal to most infants, there are still some ways you can try to prevent this from happening:

• Feed your baby in an upright position to minimise the chances of reflux.

• Ensure proper burping after feeds to release trapped air and prevent reflux.

• Avoid overfeeding by offering smaller, more frequent meals to prevent excessive stomach filling.

• Keep your baby in an upright position for at least 30 minutes after feeding to aid digestion and reduce reflux episodes.

• Consider using a specialised reflux wedge or elevating the head of the crib to promote a slight incline during sleep.

• Thicken feeds with rice cereal or other approved thickeners under the guidance of a healthcare professional to reduce reflux (only for babies who are already taking solids).

• Avoid tight clothing that puts pressure on the baby’s abdomen, as it can contribute to reflux.

• Identify and avoid potential trigger foods or drinks that may worsen reflux symptoms in breastfeeding mothers.

• Create a calm and soothing feeding environment to reduce stress and potential triggers for reflux.

• Consult with a healthcare professional for personalised advice and guidance on preventing silent reflux in babies.

Silent Reflux in Baby: When to Worry

While silent reflux is common in babies and often resolves on its own, there are situations where it’s important for parents and caregivers to be vigilant and seek medical attention. In this list, we outline key indicators that may signal a need for concern when it comes to silent reflux in babies.

1. Weight Loss or Poor Weight Gain: If your baby is consistently losing weight or not gaining weight as expected, it’s crucial to consult with a healthcare professional to evaluate if silent reflux is impacting their ability to thrive.

2. Refusal to Feed: If your baby consistently refuses to feed or demonstrates extreme fussiness and discomfort during feeding, it may indicate that silent reflux is interfering with their ability to eat.

3. Excessive Crying or Irritability: While babies may cry for various reasons, persistent and inconsolable crying, accompanied by signs of distress, could be a sign of silent reflux causing significant discomfort.

4. Respiratory Issues: If your baby experiences frequent respiratory issues such as chronic coughing, wheezing, difficulty breathing, or recurrent respiratory infections, it may indicate that silent reflux is affecting their airways and requires medical attention.

5. Sleep Disruptions: Persistent sleep disturbances, including frequent waking, difficulty settling, and restlessness, may be linked to silent reflux disrupting your baby’s sleep patterns.

6. Refusal to Lie Flat: If your baby consistently avoids lying flat and seems more comfortable in an upright position, it could be a sign that silent reflux is causing discomfort when lying down.

7. Arching of the Back: Persistent arching of the back during or after feeds, often accompanied by signs of distress, can be indicative of silent reflux and should be evaluated by a healthcare professional.

Remember, if you observe any of these signs or have concerns about your baby’s well-being, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate management.

Here at theAsianparent Singapore, it’s important for us to give information that is correct, significant, and timely. But this doesn’t serve as an alternative for medical advice or medical treatment. theAsianparent Singapore is not responsible for those that would choose to drink medicines based on information from our website. If you have any doubts, we recommend consulting your doctor for clearer information.