Silent Reflux in Babies: Causes, Symptoms, Treatment

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Reflux is a common occurrence in babies that usually begins during the first two months of life. Spitting up occurs in more than half of babies, and most babies with reflux are considered "happy spitters." This phrase refers to babies who spit up breastmilk or formula with little effort or discomfort.

In more serious cases, reflux can cause infants pain, affecting their quality of life. Babies who spit up and display symptoms of irritability are easily diagnosed with reflux, but others may not spit up at all. This is called silent reflux.

Babies with silent reflux exhibit other symptoms of gastroesophageal reflux disease (GERD), such as fussiness or poor feeding habits. However, parents of babies who don't spit up may dismiss these behaviors as colic.

What Is Silent Reflux?

Reflux occurs when the contents of the stomach come back into the esophagus. Babies with normal reflux will spit up milk or formula, whereas it stays in the esophagus for infants with silent reflux.

Reflux in babies is common and generally resolves on its own by the end of the first year.

However, medical intervention may be required in some cases. Reflux that causes symptoms severe enough to impact a baby's quality of life is referred to as GERD.

Spitting up is one symptom of GERD, but infants with silent reflux will exhibit other telltale signs.

Symptoms

Babies with silent reflux may not spit up after feedings, making it more difficult to spot. Symptoms of silent reflux include:

  • Irritability
  • Trouble sleeping
  • Choking
  • Gagging
  • Nasal congestion
  • Arching the back while feeding
  • Chronic coughing
  • Refusing to eat
  • Pauses in breathing (apnea)
  • Noisy breathing or wheezing
  • Hoarseness

Infants with reflux often present with feeding difficulties, which can slow weight gain and even cause weight loss. In extreme cases, this can result in undernutrition.

Inadequate growth or inability to maintain growth during early childhood is referred to as failure to thrive (FTT) and can occur as a result of reflux.

Causes

One reason babies are prone to reflux is that they are born with underdeveloped esophageal sphincter muscles. These are the muscles responsible for opening and closing the esophagus to allow for the passage of fluid. Reflux is more commonly seen in younger infants since these muscles mature as babies grow.

Babies with the following conditions may be at an increased risk for reflux:

Treatment

Your child's doctor will be able to determine whether your baby's symptoms are manageable by making changes at home or if medical intervention is needed. The following tips may help alleviate symptoms in babies with reflux.

Smaller, More Frequent Feedings

Feeding a baby with reflux can be challenging. Breastfed babies who have reflux may try to soothe the pain by nursing, which can exacerbate the issue.

Formula-fed infants can go longer stretches between feedings, however, this is also not ideal for babies with reflux.

Aim to feed your baby every two to three hours while awake. This may mean reducing the number of ounces your baby gets at each feeding. Overfeeding can increase abdominal pressure, which worsens reflux symptoms.

You may also find nipples with smaller holes (and a slower flow) to be helpful for your baby. Look for bottles that are designed to reduce the amount of air your baby takes in during feedings.

Keeping Baby Upright During and After Feedings

Holding your baby upright during feedings and for 30 minutes after will help reduce the symptoms of reflux. Placing your baby down to play or sleep too soon after a feeding increases the likelihood of spitting up or heartburn.

Avoid placing your baby in a car seat or chair and don't allow your baby to slouch, as this may cause abdominal compression. Doing so can help prevent discomfort or regurgitation.

Burping

Don't wait until the end of the feeding to burp your baby. Instead, burp your infant several times during a feeding—preferably after every ounce or two. This will minimize gastric pressure and the discomfort it can cause.

Frequent burping is also beneficial for preventing possible regurgitation as compared to waiting until your baby has a full stomach.

Baby Cereal

Pediatricians typically recommending waiting between 4 and 6 months to start solid foods. If your baby is presenting reflux symptoms, speak to the doctor about whether adding oatmeal to your infant's diet would be appropriate. The American Academy of Pediatrics recommends oatmeal instead of rice cereal for babies with GERD because of concerns about arsenic in rice.

You can add baby oatmeal to formula or expressed breast milk. If you are adding oatmeal to breast milk, prepare it just before feeding your baby. Breast milk enzymes can break down the oatmeal, which means it won't help with your baby's reflux.

Diet Modifications

Trace amounts of what you consume pass through to your breast milk. Just as certain foods and beverages can cause you discomfort, the same is true for your nursing baby.

Common culprits such as caffeine, chocolate, and garlic are known for worsening reflux, as are food intolerances from proteins in dairy, soy, and eggs. If you notice a pattern of increased fussiness after consuming certain foods, consider eliminating them from your diet to see if symptoms improve. Keep in mind that certain foods, like dairy, can take up to two weeks to get out of your system.

Breastfeeding mothers might also consider making changes to their nursing habits. Some women have a strong let-down reflex, which can cause babies to choke when milk is expelled too quickly.

Similarly, breast engorgement can make it difficult for your baby to latch, resulting in more air being swallowed. Briefly pumping before nursing can be helpful in either case.

Medication

Babies who choke, have breathing difficulties, or are diagnosed with failure to thrive as a result of their reflux may benefit from medication. Your child's doctor might recommend medication if your baby exhibits severe reflux symptoms that don't improve after making changes at home.

Medication is generally seen as a last resort for babies with reflux and should only be given under the guidance of your child's physician.

April 1, 2020 Update: The Food and Drug Administration (FDA) announced the recall of all medications containing the ingredient ranitidine (which helps to prevent and treat heartburn), known by the brand name Zantac. The FDA also advised against taking OTC forms of ranitidine, and for patients taking prescription ranitidine to speak with their healthcare provider about other treatment options before stopping medication. For more information, visit the FDA site.

A Word From Verywell

The majority of babies with reflux will outgrow their symptoms by 12 months, though it may linger until closer to 18 months in some cases.

Reflux is a common disorder that is generally simple to diagnose. Let your physician know about any symptoms you've noticed that may point to reflux.

Concerns about your baby's feeding habits or growth could require further evaluation. A referral to a pediatric gastroenterologist may be necessary if your baby's symptoms don't improve under the guidance of your regular physician.

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  2. American Academy of Pediatrics. Amount and schedule of formula feedings. Updated July 24, 2018.

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  4. American Academy of Pediatrics. Oatmeal: The safer alternative for infants and children who need thicker food. Updated April 18, 2016.