What is silent reflux in babies?

What is silent reflux in babies?

Everything you need to know about silent reflux in babies.

The term 'reflux' means an opposite flow of some fluid. In biology, it refers to the back-flow of stomach contents into the food pipe (oesophagus), resulting in heartburn. Sometimes, this activity can be so severe that the contents reach the oral cavity and are spit out. The situation requires immediate action because, if ignored, it can result in more severe complications.

What is silent reflux in babies?

Silent reflux, also known as laryngopharyngeal reflux, is a reflux in which the stomach contents back-flow into the pharynx and nearby respiratory passages in the throat. It is called silent reflux because it doesn't cause outward expulsion of stomach contents; the baby will not spit out the contents.

It is closely related to gastro-oesophageal reflux disease (GERD), but in GERD, the contents remain in the food pipe, causing irritation. The situation is prevalent, and some studies have found that 30-50% of babies experience reflux symptoms in the first 3-4 months.

How does this occur?

The expelled contents from the stomach reach the throat and are usually returned to the stomach, and are not spit out. So, you will not know if the baby has this condition except for some generalised signs. It can occur in babies as young as a few weeks and shouldn't last long. If it lasts for months and years and negatively influences the baby's health, you should consult the paediatrician for treatment.

What are the causes of silent reflux? How do you know if your baby has silent reflux, and when should you consult the doctor? Let's summarise some facts about the baby's reflux.

What are the causes of silent reflux?

Silent reflux can be attributed to many factors. Some of these factors are;

Weak and underdeveloped oesophageal sphincter muscles

The sphincter is a ring of muscles around an opening. Whenever these muscles constrict, the opening is narrowed and closed. The oesophageal sphincter muscles control the opening and closing of the oesophagus and the passage of contents. Sometimes, these sphincters are not fully mature or underdeveloped. These situations will result in silent reflux, but the baby will recover as the muscles mature.

Neurological disorders

The autonomic nervous system controls the functions of the sphincters. Some neurological disorders, e.g., cerebral palsy, can also disturb the functions of sphincter muscles by disrupting this nervous control.

The baby was born immature

If the baby was born immature and has a family history of silent reflux, the sphincter muscles are more likely to be weaker and will take longer to gain strength.

Risk factors

Besides these causes, some risk factors also increase the risk of silent reflux. These are;

Hiatal hernia

Hiatal hernia is a situation in which the upper part of the stomach bulges through the diaphragm, eventually reaching the chest cavity. If the baby is born with this condition, they will have more risk of acquiring silent reflux.

Baby's diet

The baby's diet in the initial months is solely liquid in most cases. It increases the risk of silent reflux because the liquids are more easily regurgitated than the solids or semi-solids.

Baby's body position

Gravity attracts everything towards the earth. When we are standing, the force of gravity pushes the contents back into the stomach and assists in keeping the stomach contents in place. But, the babies spend most of the time lying on their backs, which increases the risk of silent reflux because there is no assistance from gravity.

What are the symptoms of silent reflux?

Babies having this issue don't physically spit, which makes the condition difficult to spot. However, some complications and feeding difficulties arise, which can be spotted. These issues can cause weight loss or lower weight gain than expected. In more severe cases, the baby can go malnourished, leading to a failure to thrive (FTT). The commonly noted silent reflux symptoms are;

• Wheezing or noisy breathing

• Hoarseness (adverse changes in the quality and pitch of the sound)

• Troubled sleep

• Choking (due to excessive accumulation of contents in the throat)

• Irritability

• Nasal congestion

• Gagging

• Refusal to take food

The older children who can speak may describe a lump in the throat or a bitter taste. Besides, severe silent reflux can lead to some more symptoms, e.g.,

• Difficult breathing

• Chronic cough

• Arched back during feeding

How is silent reflux treated?

If the symptoms of acid reflux are apparent, you should consult the paediatrician for treatment. Common treatments used are antacids, proton pump inhibitors and H2 blockers to reduce the acid production in the stomach and neutralise the acid already produced.

Another practical option is to use pro-kinetic drugs, which increase the motility of small intestines to allow faster stomach emptying. The stomach contents will stay for a short time in the stomach, reducing the risk of salient reflux.

Our Acid Reflux Treatment and Medicine page has many products related to acid reflux treatment. Click here to visit the page and order the products after consulting our health professionals. Heartburn is a related condition which is due to acid reflux and GERD. Click here to view heartburn treatment medicines.

How can you manage the acid reflux symptoms at home?

Not all cases require the use of drugs. The doctor may also be reluctant to use drugs if the baby's health is unsatisfactory. There are some options you can try at home. These include;

Dietary modifications

What you eat can also influence your baby. Trace amounts of nutrients and other things from your food also reach the baby through breast milk. So, if you keep yourself away from some foods that aggravate the acidity, e.g., garlic, chocolate, dairy, eggs, dairy products, caffeine etc., it will also help your baby. Remove the acidic foods from your and your baby's diet, e.g., tomatoes, citrus etc.

Also, don't include any food in the baby's diet that can aggravate the acidity.

Change nursing habits.

The let-down reflex causes the release of milk from the breasts. The women often note a tingling sensation in their breasts and feelings of fullness. The sucking pattern of the baby also changes from more petite and shallow sucks to more powerful sucks.

A strong let-down reflex can cause choking, particularly when a large quantity of milk is expelled too quickly. Similarly, breast engorgement makes a baby more likely to swallow more air. Using a breast pump for some time before nursing can also help manage the strong let-down reflex.

Regularly burp the baby.

Some people do burping towards the end of a feeding. But, burping a baby several times during feeding can do more help, and it would be better to do burping after every 1-2 ounces of food. As it is difficult to estimate the quantity during breastfeeding, you can try burping after 1-2 minutes.

This practice will reduce gastric pressure and its related discomfort.

Offer feeding in more frequent and smaller meals

Feed your baby after every 2-3 hours during awakening. This practice will reduce the amount of food per feeding, increase the number of daily meals, and reduce the symptoms of acid reflux, as overfeeding is often a cause of the problem. Overfeeding results in more pressure inside the stomach, producing more forceful expulsions.

Also, use feeding bottles that don't allow or reduce the air the baby is engulfing during feeding, as the air also does the same job.

Keep your baby in an upright position after feeding.

It is a good practice to hold the baby upright for at least 30 minutes after the feeding. It will help prevent the symptoms of silent reflux. Don't place the baby in the car seat or any other seat that doesn't allow the baby to slouch. Take care to carry the baby in an upright position when moving.

Offer solid foods

Commonly, the baby is offered solid food after 4-6 months. However, if the baby is showing silent reflux symptoms, consult the paediatrician to add cereals, e.g., oatmeal, to your baby's food. This practice will reduce the risk of silent reflux by changing the consistency of the stomach contents.

Choose an appropriate feeding technique.

Swallowing the air can be a risk factor, so choose the feeding bottle (if using) that doesn't allow the air to enter and stays full of milk while the baby is drinking milk. Also, adjusting the angle while feeding may also be beneficial.

Switching to an amino acid or hydrolysed protein formula milk will be helpful if your baby is on the formula milk.

When to see a doctor?

The silent reflux is likely to subside with these measures. However, some situations require you to seek paediatrics help. Look for these situations, e.g.,

• Difficulty in feeding

• The child is experiencing sustained weight loss or is not gaining as expected

• The baby is experiencing pain in the ear which is reflected by tugging on the ears and irritability

• Breathing difficulties, e.g., laboured breathing and wheezing.

• There are signs of respiratory failure, e.g., bluish lips, which show the baby is not getting enough oxygen.

How much time does this reflux take to resolve?

In the majority of cases, this reflux resolves spontaneously. As the child grows, the sphincters gain strength, and it is likely to disappear by the time of the first birthday.

The techniques mentioned above are likely to ensure survival without any severe complications. However, some long-term complications can arise if the delicate respiratory tissues are regularly exposed to stomach acids. These include;

• A constant and chronic cough

• Chronic laryngitis

• Pneumonia

• Laryngopharyngeal cancer is rarely seen in advanced and severe cases.

Bottom-line

Many children in their first-year experience silent reflux as it usually starts around 2-3 weeks of age and reaches its peak by 4-5 months. However, by the time of the first birthday, the baby will likely outgrow the symptoms. It is easy to diagnose with symptoms, but sometimes, it becomes difficult to diagnose and is confused with other abdominal issues, e.g., colic.

Ask your doctor in case of any issues and complications. However, consulting a gastroenterologist or paediatrician may become necessary in more complicated cases.

Gut health is essential for you, and you should take the doctor's help in case of any complications. At Welzo.com, our team of gastroenterologists is available for you. Click here for online consultation.

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