Symptoms and remedies for silent reflux in babies

Regular reflux occurs when food and digestive acid leaks up from the stomach, causing painful irritation in the esophagus. But silent reflux in babies 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.

Ignoring silent reflux can be harmful. effects on a baby’s health. According to Dr. Raj Dasgupta, MD, a board-certified doctor in critical care, internal medicine, pulmonology, and sleep medicine, the potential repercussions of leaving silent reflux unchecked include esophagitis (inflammation of the esophagus), feeding difficulties, irregular weight changes, respiratory issues, and sleep disturbances.

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.

Head elevation doesn't improve baby's silent reflux 

While some doctors may still recommend placing a towel under the crib mattress or a wedge under the crib sheet, in 2016 the American Academy of Pediatrics published a report stating that elevating the head of the crib is not effective in reducing reflux.

"It may result in the infant sliding to the foot of the crib into a position that may compromise respiration and therefore is not recommended," the report states. The risk of SIDS outweighs the benefits of allowing your baby to sleep on his stomach or side.

Let nature take its course 

Your doctor may also recommend thickening agents to mix with formula or breastmilk, and might prescribe a medication to reduce stomach acidity. But 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.”

Dr. Dasgupta reassures parents that reflux is a temporary condition for most infants. He further elaborates, “Silent reflux often resolves between 12 and 18 months of age, coinciding with the maturation of the digestive system and the infant's transition to spending more time in an upright position.”

You may want to try a gripe belt

While gripe water and baby gas relief measures come with mixed reviews, many parents swear by gripe belts during their babies awake hours. Doctors caution against letting babies sleep in these, so take note. They work by encouraging baby to use their abdominal muscles, pushing gas and acid into place in a more natural way than just snoozing or sitting in a stroller might.

The best part? These fun toys offer plenty of engagement and sensory stimulation.

A pacifier may help 

Utilizing a pacifier could prove beneficial for infants experiencing silent reflux. Dr. Dasgupta explains, "Research suggests that pacifiers can aid babies suffering from silent reflux. The sucking motion stimulates saliva production, which helps neutralize stomach acid, while the act of sucking itself has a calming and soothing effect on the baby."

Let your baby sleep on their back 

According to Dr. Dasgupta, the safest sleep position for a baby with silent reflux is on their back. “This positioning has been extensively researched and found to decrease the likelihood of SIDS, a potentially life-threatening condition,” he says.

As the child grows older, however, Dr. Dasgupta suggests that sleeping on the left side becomes the most beneficial for managing reflux. He explains to Today’s Parent, “This recommendation stems from the fact that the left-side position keeps the esophageal sphincter elevated above the level of the stomach contents, thus reducing the risk of acid regurgitation.”

Oatmeal thickens stomach contents

As your little one reaches the four to six-month milestone, it's often recommended to introduce solid foods like oatmeal into their diet.

According to Dr. Dasgupta, this can be a helpful strategy to combat reflux by thickening the contents of your baby's tummy. However, it's crucial to consult with your pediatrician for personalized guidance on the appropriate timing and approach to starting solids.

Try smaller feedings

Dr. Dasgupta recommends trying smaller, more frequent feedings as a strategy to ease silent reflux in infants.

"Giving your baby smaller amounts of milk or formula at closer intervals can help keep their stomach from getting too full," he explains, "and this, in turn, can reduce the instances of reflux they experience."

Look for the right bottles and bottle nipples

If your little one suffers from silent reflux, it's crucial to choose the appropriate bottles and nipples.

Dr. Dagupta suggests investing in bottles and nipples specifically designed to minimize air ingestion. “These specialized products often feature angled bottles or vent systems, which can help alleviate the discomfort associated with reflux,” he explains.

Keep baby upright after feedings 

Maintaining an upright position for infants after feeding can be beneficial in mitigating the symptoms of silent reflux.

Dr. Raj advises, "Holding a baby in an upright posture for 20 to 30 minutes following a meal can aid in preventing the backflow of stomach contents, thereby alleviating reflux discomfort."