Reflux is a very common condition amongst small babies which will usually begin within the first two months. Most babies who experience reflux will spit up their milk during or after a feed and in these cases it is easy for parents to know that their child is suffering from reflux. Some babies with reflux don’t spit up at all and it can be much more difficult for parents to diagnose the problem. This is what we call silent reflux. Silent reflux babies will show other symptoms such as excessive crying, poor feeding habits and sleep problems.

What’s so silent about silent reflux?

Instead of throwing up, babies with silent reflux swallow the milk that comes up their oesophagus. The signs aren't always noticeable and you don't see your child constantly vomiting, hence the word "silent". It can be incredibly heartbreaking not understanding what is causing your child pain. You could second-guess your every step as a parent or caregiver, and wonder when, oh when, you'll have a happier and more relaxed baby.

Symptoms of silent reflux

Crying (and crying and crying and crying…)

Tears are your baby's way of communicating that they're in pain. However, many babies with reflux won't cry; instead, they'll be difficult to calm or get to sleep. But first, it's important to remember that just because your baby is crying a lot doesn't mean they have silent reflux.

There may be a variety of underlying problems causing those tears. Before you suspect silent reflux, make sure you've ruled out anything on our list that might be causing your baby to cry. Here is a list of the most common signs...

Problems feeding

Whether your little one is on the boob or bottle, there will more than likely be some feeding issues occurring if they are suffering with silent reflux. They may gag and cough while sucking, seem "fussy" and move away from the breast or bottle, or they may refuse to eat at all.

Alternatively, some reflux babies will "snack" a lot, either because feeding hurts and they stop, or because more milk going down and pushing acid back down is calming. They can also have difficulty swallowing or burping. Sometimes, babies with extreme silent reflux will arch their backs during or shortly after feeding.

So, will taking a bottle help? There seems to be a misconception that reflux occurs more in breastfed babies, but changing from breast to formula feeding will usually not solve the problem. It’s the act of having any liquid in their tummy that matters.

Sleeping issues

Babies with silent reflux are unlikely to be good sleepers. They'll often take a long time to fall asleep, and once asleep, they'll often wake up after a brief period of time, crying.

Your baby will be much more comfortable falling asleep while lying semi-upright, especially either on you or in a baby carrier. This is because when being held upright, gravity helps prevent acid and milk from rising up and causing irritation.

If your baby won't settle, sleep deprivation sets in for both of you. This, combined with seeing your baby in pain, can drive you insane! However, some babies with reflux will sleep soundly both during the day and at night. It’s possible they're simply exhausted or they may not ‘reflux’ too much overnight.

Other reflux signs

As well as the above, a baby with silent reflux may also suffer from one or more of the following:

• Coughing, but without other sickness symptoms 
• Being really noisy and making strange sounds like gagging, grunting and having a hoarse voice
• It may seem they are more “mucusy” than other babies
• They may drool a lot more
• They may pick up frequent colds and ear infections
• Have bad breath.
• Bubbles around their mouth
• Hiccuping frequently

Causes Of Silent Reflux

The primary reason that reflux is so common in babies is that when they are born their esophageal sphincter muscles are underdeveloped. This means that newborn babies are not as capable as older children when it comes to opening and closing their esophagus to allow for the passage of fluid. As your baby grows these muscles will naturally become stronger and eventually they will grow out of silent reflux once their digestive system is more developed.

Babies with the following conditions are at a higher risk of developing reflux:

• Neurological disorders such as cerebral palsy
• Premature babies
• A family history of reflux
• Hiatal hernia
• A weak upper stomach valve

Treatment For Silent Reflux

It’s a good idea to consult with your pediatrician about the severity of your baby’s symptoms. Depending on the individual circumstances, sometimes a baby with silent reflux may need medical intervention such as prescribed medication. In any case, we have put together our top tips for alleviating your baby’s symptoms just by making some adjustments to their daily routine.

Smaller, More Frequent Feedings

Feeding a baby with reflux can be quite the challenge for moms. Breastfed babies who are struggling with reflux might try to soothe the pain by nursing and in turn over-feeding, which can cause their little belly to become too full and make the problem even worse. If your baby is formula-fed, they can probably go for longer stretches between feedings which is also not ideal when dealing with reflux. During their waking hours, you should aim to feed your baby every two to three hours. This may mean reducing the amount of milk your baby gets during a feed so as not to overfeed them. It can also be useful to look for bottle nipples with smaller holes so that you have more control over the milk flow when bottle feeding your baby.

Keeping Your Baby Upright During and After Feedings

Even if your baby is sleepy after feeding, you should resist the urge to lay them down as this will worsen their reflux symptoms. Holding your baby in an upright position for thirty minutes after a feed will help them to digest and reflux will be less likely to occur. You should also avoid placing your baby in a car seat or chair until after the thirty minutes has passed as an elevated position may cause abdominal compression which can be quite painful for them.

Burping

Rather than waiting until feeding is over to burp your baby, it is best practice taking breaks during feeding to burp them. This will help to make sure that their tummy doesn’t get too full and will also prevent trapped wind. Getting into the habit of burping your baby frequently will ease their overall digestive discomfort associated with silent reflux.

Diagnosis of reflux

A GP or specialist may make a diagnosis based on symptoms described by the parents. If you suspect your baby is suffering from silent reflux, make a list of as many of the symptoms as possible. When babies with reflux are distracted, they are usually happier, meaning people, including doctors, do not realize they are in a lot of pain.

It's a smart idea to take a video of when your baby is having an episode, to take along to your appointment. A few diagnostic tests are available, including a barium swallow sequence, a PH probe, and an upper GI endoscopy.

To help with reflux, products like the babocush comfort cushion can hold your baby on their tummy. The extra comfort of a gentle vibration and heartbeat sound helps too - for added relaxation. To read more about how the babocush can help your baby, visit our website.