What Is Silent Reflux in Babies?

Babies with silent reflux don't spit up like babies with typical reflux do

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Reflux is common in babies and usually begins during the first two months of life. Silent reflux is a type of reflux that doesn't include spitting up.

More than half of babies with reflux spit up, and most are considered "happy spitters." These are 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 may exhibit other symptoms of gastroesophageal reflux disease (GERD), such as fussiness or poor feeding habits. But because they don't spit up, their symptoms may be mistaken for colic.

Reflux occurs when the contents of the stomach come back into the esophagus. Babies with typical reflux will spit up breast milk or formula, but in babies with silent reflux, the milk or formula stays in the esophagus. Reflux 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 of Silent Reflux in Babies

Babies with silent reflux may not spit up after feedings, making it more difficult to spot. Infants with silent reflux also 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.

Symptoms to Look For

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

Causes of Silent Reflux

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 neurological disorders, such as cerebral palsy, as well as those who are premature or have a family history of reflux may be at an increased risk for reflux. Having a hiatal hernia or a weak upper stomach valve also may increase the risk for reflux.

Treatment of Silent Reflux

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

Offering 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. An upright position can help prevent discomfort and spitting up.

Burping Your Baby

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

Offering Baby Cereal

Pediatricians typically recommending waiting until your baby is 4 to 6 months old to start solid foods. If your baby is presenting reflux symptoms, ask 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.

Making 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. Caffeine, chocolate, and garlic may worsen reflux. Your baby may also not tolerate 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.

You might also consider making changes to your nursing habits. Some people 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 them swallowing more air. Briefly pumping before nursing can be helpful in either case.

Using 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 healthcare provider 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, although silent reflux may be confused with colic. Let your healthcare provider know about any symptoms 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 provider.

Frequently Asked Questions

  • How long do babies have silent reflux?

    Reflux is a common disorder that most babies will outgrow by the time they are 9 to 12 months of age. Keep your baby's healthcare provider informed of their symptoms and any changes you observe.

  • At what age does silent reflux peak?

    According to the American Academy of Pediatrics, reflux usually begins at approximately 2 to 3 weeks of age and peaks between 4 to 5 months. Most babies who are born at full term will stop showing signs of reflux by their first birthday.

  • What happens if silent reflux is left untreated in babies?

    Because babies often refuse to eat or have trouble eating when they have silent reflux, there is a risk that they not grow as they should. In extreme cases, they may develop failure to thrive, which is an abnormal pattern of weight gain caused by the lack of sufficient usable nutrition. If your baby is not feeding consistently or appears to be in pain, speak with a healthcare provider right away.

6 Sources
Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Academy of Pediatrics. Reflux (spitting up).

  2. American Academy of Pediatrics. Amount and schedule of formula feedings.

  3. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. doi:10.1097/MPG.0000000000001889

  4. American Academy of Pediatrics. Oatmeal: The safer alternative for infants and children who need thicker food.

  5. American Academy of Pediatrics. Gastroesophageal reflux & gastroesophageal reflux disease: Parent FAQs.
  6. American Family Physician. Failure to thrive: A practical guide.

By Renee Plant
Renee Plant is a health and wellness freelance writer with a passion for delivering well-researched, factual content to readers.