Silent reflux, also called laryngopharyngeal reflux (LPR), is a type of reflux in which the contents of the stomach flow back into the larynx (the voice box), back of the throat and nasal passages. The term "silent" comes into play as the reflux is not necessarily causing any visible symptoms.
Instead of being expelled from the mouth, the regurgitated stomach material can fall back into the stomach, which can make detection difficult.
Reflux is common in babies as young as a few weeks old. If it persists beyond a year or causes negative side effects for your child, treatment may be recommended by your paediatrician.
Does my baby have silent reflux?
For around one in five babies, reflux symptoms can be seen. While gastroesophageal reflux disease (GERD) and LPR may exist together, the symptoms of silent reflux differ from those of other reflux types. Typical symptoms for babies and young children include:
- Breathing problems, such as wheezing, “noisy” breathing, or pauses in breathing
- Chronic coughing
- Spitting up
- Difficulty feeding
- Nasal congestion
- Chronic respiratory conditions (such as bronchitis) and ear infections
- Difficulty breathing (your child may develop asthma)
Babies with a silent reflux may not spit up, which can make identifying the cause of their distress difficult. Older children may describe something in their throat that feels like a lump, and complain about a bitter taste in their mouth. You may also note a hoarseness in your child’s voice.
What causes silent reflux?
Babies are susceptible to reflux for a variety of factors. At conception, babies have undeveloped oesophageal sphincter muscles. These are the muscles which open and close at each end of the oesophagus to allow the passage of fluid and food.
The muscles become more flexible and balanced as babies develop, keeping the contents of the stomach where they belong. This is why reflux is most often seen in younger infants who often spend a lot of time on their backs - a position that can really aggravate reflux symptoms.
Lying on their back means babies don't have the advantage of gravity to help hold any food in the stomach. A baby’s mostly liquid diet can also aggravate reflux as liquids are more easily regurgitated than solid foods.
What can I do to manage or prevent silent reflux?
There are several steps you can take to help ease your baby’s reflux. The first is alteration of your diet if you are breastfeeding. This will help to minimise sensitivity to any products your child may be allergic to. The American Academy of Pediatrics (AAP) recommends two to four weeks of removing eggs and milk from your diet to see if reflux symptoms begin to improve.
Other recommendations include:
- If possible, keep your baby upright for 30 minutes after feeding.
- Feed your baby little and often.
- If you are bottle feeding, hold the bottle at an angle, keeping the teat full of milk. This will help to reduce the amount of air your baby swallows. Swallowing air can increase bowel pressure and cause reflux.
- Burp your baby several times throughout feeding.
- Try different teats to see which one gives your baby the best seal around their mouth.
When to seek help
Most babies can thrive despite having silent reflux but seek medical attention if your baby has a frequent cough, breathing difficulties (such as wheezing, labored breathing or if your baby’s lips turn blue), persistent ear pain or difficulty gaining weight.
For additional support, here are six tips for coping with baby reflux.