What Is Silent Reflux In Babies?

Silent reflux in infants, also known as laryngopharyngeal reflux (LPR), is the reflux of stomach acid back into the esophagus without causing visible vomiting.

While normal acid reflux is easy to detect because there is visible vomiting, silent acid reflux can be difficult to detect. A baby with silent acid reflux may seem uncomfortable, cry more than usual, or have trouble eating and sleeping. This is caused by the underdevelopment of the lower esophageal sphincter, the muscle that holds the stomach contents in place, which is common in infants.

• What is silent reflux in babies?
• Symptoms of silent reflux in babies
• What causes silent reflux in babies?
• How to treat silent reflux in babies?
• When does silent reflux go away in babies?
• Conclusion

What is silent reflux in babies?

Silent reflux in babies, also known as laryngopharyngeal reflux (LPR), occurs when stomach acid moves back into the esophagus without causing the typical signs of reflux, like spitting up.

Unlike regular reflux, where babies often vomit or bring up milk, silent reflux doesn’t always involve visible vomiting. Instead, the acid irritates the throat and airways, leading to symptoms like coughing, gagging, or difficulty feeding.

Some babies might appear to be in pain or have trouble sleeping, but the reflux is not as noticeable as with regular reflux. It happens because the muscle that should keep food and acid in the stomach isn't fully developed in infants, causing acid to drain from the stomach.

Symptoms of silent reflux in babies

Below are some symptoms of silent reflux in babies:

Frequent crying or irritability

Babies with silent reflux may cry or seem irritable, especially during or after feedings. Discomfort caused by stomach acid irritating the esophagus can make them irritable, even if they are not spitting up.

Difficulty in feeding

Babies with silent reflux may refuse to eat or pull away from the bottle or breast during feedings. This is because feeding can aggravate throat irritation and cause pain or discomfort.

Coughing or swallowing

Silent reflux can irritate the back of your baby's throat, causing frequent coughing or swallowing. This may be more pronounced during or after feeding.

Arched back

Some babies may arch their backs during or after feeding, which is a reflex action to relieve discomfort caused by refluxed acid in the esophagus.

Poor sleep

Silent acid reflux can make it harder for your baby to sleep. They may wake up frequently, especially when lying flat on their backs, because of the discomfort caused by acid reflux into the throat.

Wheezing or hoarseness

If acid reflux irritates your baby's airways or vocal cords, they may wheeze or have a hoarse voice. This happens because stomach acid reaches the throat and affects the upper respiratory system.

Frequent burping

Babies with silent reflux may burp more than usual. This occurs because the stimulation of stomach acid triggers spasms in the diaphragm.

Difficulty in gaining weight

If your baby is eating less because of discomfort or spitting up small amounts of unnoticeable food, it may not gain as much weight as expected. Silent reflux can indirectly affect their growth if feeding becomes too difficult or painful.

These symptoms can also occur for other reasons, so parents should always consult their pediatrician if they suspect their baby has silent reflux.

What causes silent reflux in babies?

Here are some reasons about what causes silent reflux in babies:

Lower esophageal sphincter (LES) hypoplasia

The lower esophageal sphincter is the muscle that prevents the stomach contents from flowing back into the esophagus, but in infants, the lower esophageal sphincter is not yet fully developed, so silent reflux often occurs. The lower esophageal sphincter usually closes tightly after food enters the stomach, but in infants, it may be weak or not yet working properly.

Liquid Diet

Infants are completely dependent on milk or formula, which is liquid and can easily back up into the esophagus. The liquid nature of the diet can make it easier for stomach contents to reflux, especially if the baby lies down just after feeding.

Lying down most of the time

Babies who lie flat on their backs for long periods of time are more likely to have stomach acid move upward. Gravity works against them, unlike older children or adults who sit upright most of the time.

Small stomach capacity

Babies have small stomachs that fill up quickly with milk. If they eat too much or too quickly, the pressure in the stomach increases, which may cause some of the contents to back up into the esophagus.

Immature digestive system

An infant's digestive system is still maturing, which means it may not process stomach acid as efficiently as an older child. This immaturity can make infants more susceptible to reflux, including silent reflux.

Swallowing air during feeding

Whether bottle-fed or breast-fed, babies swallow air when they eat. This extra air increases the pressure in the stomach, making it easier for stomach acid to flow into the esophagus.

Overfeeding

Feeding too much at once or feeding too often can lead to reflux. A full stomach increases the chances of acid backing up into the esophagus, especially in infants who already have weak acid reflux.

These factors are common in most infants, which is why silent reflux is not uncommon in the first few months of life. Silent reflux often improves over time as the infant's digestive system and feeding habits mature. However, if symptoms persist or seem severe, be sure to consult your pediatrician.

How to treat silent reflux in babies?​

Silent reflux often improves as babies grow and their digestive systems mature. Patience and persistence can go a long way toward reducing symptoms and keeping your baby comfortable.

Smaller, more frequent meals

Instead of feeding in large quantities, parents can try smaller meals. This reduces the amount of milk in your baby's stomach at one time, which reduces the chances of reflux.

Keeping your baby upright after feeding

Keeping your baby upright for about 20 to 30 minutes after feeding can help gravity push down the stomach contents. During this time, gently tilting your baby's body can reduce discomfort.

Burping frequently during feeding

Burp your baby during feedings can help release trapped air that may be adding pressure to the stomach. This can reduce the likelihood of reflux episodes.

Adjusting the breastfeeding position

Feeding your baby in a slightly reclined position rather than lying flat on your back can help reduce reflux. This position allows the milk to flow down naturally and minimizes the chances of reflux.

Avoid overfeeding

Measuring out the proper amount of formula or making sure your baby doesn't overeat while breastfeeding can help prevent reflux. Overfeeding can increase pressure on the stomach, which makes reflux more likely.

Consider thickening feedings

Some pediatricians may recommend thickening the formula with a small amount of grain to make it less likely to reflux. This should only be done under a doctor's supervision, as it is not appropriate for all babies.

Safe use of an inclined sleep surface

While babies should always be placed on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS), pediatricians may recommend a slight incline in some cases. Parents should ensure that the sleep surface is safely adjusted under the guidance of a professional.

Evaluating and adjusting diet (for breastfeeding mothers)

If the infant is breastfed, the mother can try skipping common trigger foods, such as dairy or caffeine, to see if this reduces symptoms. However, this should be done gradually under the supervision of a doctor.

Consult your pediatrician

If lifestyle adjustments don't help, or if symptoms seem severe, it's time to consult a pediatrician. In some cases, they may recommend medications to reduce stomach acid or control discomfort.

When does silent reflux go away in babies?

Silent reflux in infants often improves as they grow and their digestive systems mature. Most cases begin to improve by the time babies are 4 to 6 months old, when the lower esophageal sphincter (LES), the muscle that keeps the stomach contents in place, becomes stronger.

For many babies, silent reflux symptoms disappear completely by 12 months of age, especially if they have more time to sit up straight, eat solid foods, and stop eating only liquid foods.

However, if symptoms persist beyond one year of age or seem severe, parents must consult their pediatrician for further evaluation and guidance.

Conclusion

Silent reflux in infants can be difficult to recognize, but understanding the causes and symptoms can help parents address the problem effectively. It occurs because a baby's digestive system is still developing, causing stomach acid to flow back into the esophagus without significant spitting up. Although it can cause discomfort and interfere with feeding or sleep, silent reflux often improves as your baby grows. Simple adjustments such as feeding small amounts, keeping the baby upright after meals, and consulting a pediatrician when necessary can make a big difference. Most importantly, for many babies, silent reflux is a temporary phase that usually resolves as their digestive system matures.