Solving the mystery of silent reflux.
Photo: Emma Innocenti/Getty Images
Any parent whose newborn has suffered from reflux knows the helplessness of trying to comfort an infant who hurts after each feeding. Babies with reflux may be irritable, spit up or refuse to eat. They arch their bodies during or after feedings, or cry when placed on their backs, especially if they just ate. But sometimes the most obvious symptoms don’t show up — this is known as “silent reflux.” Regular reflux occurs when food and digestive acid leaks up from the stomach, causing painful irritation in the esophagus. But babies with silent reflux might not spit up at all, swallowing the regurgitated liquid instead. Some babies with regular reflux lose weight, but babies with silent reflux can gain weight normally, despite being in pain.
Emily Parks, a Halifax mom, knows this first-hand. Initially, she and her husband thought they simply had a high-needs baby who cried a lot and never wanted to be set down. But Parks soon began to suspect something else was going on. “I noticed he was making a lot of choking and gagging noises immediately after feeding,” she says. “And his screaming seemed to indicate really acute pain.” Parks’ experience is a classic case of silent reflux, says Catherine Pound, a paediatrician at the Children’s Hospital of Eastern Ontario in Ottawa. “An infant’s symptoms could include a hoarse voice, a chronic cough, pauses in his or her breathing, or asthma-like symptoms.” Other telltale signs are gagging and choking, throat irritation, sour breath, a constant runny nose and wheezing. Severe reflux that continues for more than a few months can cause damage to the infant’s esophagus, stomach and throat.
Pound explains that babies are susceptible to reflux — silent or otherwise — because they spend a lot of time lying down, their diet is mostly liquid and their muscle tone, including the muscle tone of the sphincter between the stomach and the esophagus, is less developed. Fortunately, some simple measures can provide relief. Pound suggests placing a rolled towel under the head of the crib mattress to elevate it 30 degrees, and holding your infant upright for 20 to 30 minutes after each feeding. Your doctor may recommend thickening agents to mix with formula or breastmilk, and might prescribe a medication to reduce stomach acidity. Time may be the best medicine of all, as reflux sometimes clears up after the first several weeks, once your baby’s muscle tone increases, and he starts spending more time sitting up, then standing, and eventually eating solids.
“Between six and eight weeks it started to get better,” says Parks. “By then he slept in his bassinet for a few hours each night, which gave me a bit of sanity to get through it.” By four months, his reflux symptoms had disappeared, without medication. “We were lucky. It cleared up on its own.”
A version of this article appeared in our September 2012 issue with the headline “Silent suffering,” p. 80. Want to talk to other parents about this issue? Join the “Baby Health” board in our forums.