Reflux is a common problem in babies, and it usually starts in the first two months of life. More than half of babies spit up, and the majority of babies with reflux are considered ‘happy spitters’.
Reflux, in more acute cases, can cause pain in babies. Reflux is easily recognised in babies who spit up and have irritability symptoms, however some babies may not spit up at all. This is referred to as silent reflux. Other signs of gastroesophageal reflux disease (GERD) in babies with silent reflux include fussiness and poor feeding habits. Parents of babies who do not spit up, on the other hand, may confuse their babies symptoms with colic.
What Is Silent Reflux?
Laryngopharyngeal reflux (LPR), also known as silent reflux, is a condition that occurs when stomach contents reflux or back up into the larynx (voice box), the back of the throat, and the nasal passages. Unlike gastroesophageal reflux (GER), which may cause heartburn and regurgitation, silent reflux does not typically show these noticeable symptoms. Hence, it is termed "silent."
Though silent reflux can occur in people of all ages, it is common in newborns - often starting in the first few weeks of life. This is primarily due to the immaturity of their esophageal sphincters, the muscles at the junction of the oesophagus and the stomach. As a baby grows and their digestive system matures, the frequency of reflux episodes decreases. Most babies outgrow the condition by their first birthday. However, in some cases, silent reflux may persist beyond the first year or cause complications such as poor growth, difficulty swallowing, or respiratory problems. In such cases, medical intervention may be required.
Regurgitated stomach contents can go back into the stomach rather than being ejected from the mouth, making diagnosis difficult. Reflux occurs frequently in babies as young as a few weeks old. Your doctor may recommend treatment if it lasts more than a year or creates problems for your baby.
A common thread amongst many reflux babies is that they will display an unprecedented amount of crying due to their digestive discomfort and can be extremely difficult to settle. Babies with silent reflux may not spit up after feedings, making it more difficult to spot. Other symptoms of silent reflux include:
- Trouble sleeping
- Nasal congestion
- Arching the back while feeding
- Chronic coughing
- Refusing to eat
- Pauses in breathing (apnea)
- Noisy breathing or wheezing
Feeding difficulties are common in babies with reflux, which can impede weight gain or even cause weight loss. In severe circumstances, this might lead to malnutrition.
Failure to thrive (FTT) is defined as a lack of or inability to maintain growth during early life, and it can be caused by reflux.
Causes Of Reflux In Babies
One reason babies are prone to reflux is that their esophageal sphincter muscles are undeveloped when they are born. These are the muscles that allow fluid to travel through the oesophagus by opening and closing it. Because these muscles mature as new borns grow, reflux is more common in younger babies. Babies also spend a lot of time laying on their backs, especially before they learn to roll over which usually happens when your baby is between four to six months old. Lying on the back means that babies don’t have the benefit of gravity to help keep food in their stomach. However, you should always put your baby on their back to sleep to reduce the risk of suffocation. The mostly-liquid diet of babies can also contribute to reflux as liquids are easier to regurgitate than solid food.
Reflux may be more common in babies with the following conditions:
- Neurological disorders, such as cerebral palsy
- A family history of reflux
- Hiatal hernia
- Weak upper stomach valve
Treatment For Baby Reflux
As parents, we want to do everything we can to ensure our babies are comfortable and thriving. When your baby experiences symptoms such as frequent spitting up, irritability during feeding, or disrupted sleep, it could indicate a reflux issue. Consulting with your baby's pediatrician is vital, as they can determine whether the symptoms can be managed at home or if medical intervention is necessary.
Smaller, More Frequent Feedings
One common strategy to help manage reflux in babies is to offer smaller, more frequent feedings. Instead of large meals spaced out every 3 to 4 hours, aim to feed your baby every 2 to 3 hours while they are awake. This approach can prevent overeating, which can exacerbate reflux symptoms by increasing pressure on the lower esophageal sphincter (the muscle that prevents food and stomach acid from flowing back into the esophagus).
The amount of milk your baby requires at each feeding will depend on their age, weight, and overall health. Your pediatrician or a lactation consultant can provide guidance on how much your baby should eat at each feeding.
Keeping Baby Upright During and After Feedings
Holding your baby quite upright during feedings and for 30 minutes afterward can help to alleviate reflux symptoms. Spitting up or heartburn might occur if your baby is put down to play or sleep too soon after a feed. Avoid putting your new born in a car seat or a chair, and don't let them sit in a slumped position because this can create abdominal compression. These techniques can reduce the likelihood of discomfort or regurgitation.
Burping your baby is an essential part of the feeding process, especially for newborns and young infants. When babies feed, they often swallow air, which can lead to gas and discomfort in their stomach. Burping helps release this trapped air, reducing pressure on the stomach and the associated discomfort.
Timing of Burping
Rather than waiting until the end of a feed, it's beneficial to burp your baby multiple times throughout each feed. For bottle-fed babies, aim to burp your little one after every ounce or two of formula or breast milk. If you're breastfeeding, try to burp your baby when you switch from one breast to the other.
The rationale behind this is that when you burp your baby more frequently, you're helping to expel air before it accumulates in their stomach. This reduces the pressure that can force milk and stomach acid back into the esophagus, potentially leading to regurgitation and discomfort.
Techniques for Burping
There are several techniques for burping your baby effectively:
- On your shoulder: Hold your baby against your chest so their chin is resting on your shoulder. Support them with one hand and gently pat or rub their back with the other.
- Sitting on your lap: Sit your baby on your lap facing away from you. Use one hand to support your baby's body, with your palm supporting their chest while your fingers gently support their chin and jaw. Lean your baby slightly forward and gently pat or rub their back with your other hand.
- Face down on your lap: Lay your baby face down on your lap so they're lying across your knees, perpendicular to your body. Support their chin and jaw with one hand. Make sure your baby's head isn't lower than the rest of their body so blood doesn't rush to their head. Pat or rub their back with the other hand.
Remember to always burp your baby gently. Too much pressure on your baby's belly can cause discomfort.
In addition to burping during feeding, it's also important to burp your baby after feeding. Keeping your baby in an upright position after feeding can help prevent reflux and encourage burping. Keep in mind that every baby is different. Some babies burp frequently, while others rarely need to burp. If your baby doesn't burp after a few minutes, they may not need to. However, if your baby seems uncomfortable during or after feeding, burping more frequently may help.
Giving your baby tummy time each day will help aid in their digestion with the benefit of gravity to help them hold their milk in their stomach. Regular tummy time also allows your baby to strengthen their muscles and progress through their developmental milestones whilst improving their digestive system. This means that your baby will work their way towards outgrowing silent reflux.
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A small portion of what you eat makes its way into your breast milk. Your nursing baby is susceptible to the same foods and beverages that cause you discomfort. Caffeine, chocolate, and garlic, as well as food intolerances to proteins in dairy, soy, and eggs, are known to aggravate reflux. If you detect a pattern of fussiness after eating certain foods, try cutting them out of your diet to see if your symptoms improve. Remember that some foods, such as dairy, might take up to two weeks to leave your system.
Breastfeeding women might think about changing their breastfeeding practices as well. When milk is expelled too quickly, it can cause newborns to choke. Some mothers have a strong let-down reflex. Breast engorgement, on the other hand, can make it difficult for your baby to latch, causing more air to be swallowed. In either instance, briefly pumping before nursing can be beneficial.
There are certain medications which may help babies who choke, have breathing problems, or are diagnosed with failure to thrive as a result of their reflux. If your baby's reflux symptoms are severe and don't improve after making modifications at home, your baby's doctor may prescribe medication. For babies with reflux, medication is usually only prescribed as a last resort and should only be given under the supervision of your child's physician.
If your baby is struggling with sleep and feeding issues and is particularly irritable with prolonged frequent crying stints then they may be suffering from silent reflux. You can help to alleviate symptoms for your baby by feeding them smaller amounts of milk more frequently throughout the day. Holding your baby in an upright position for thirty minutes after feeding will aid in their digestion. During this time you should also burp your baby thoroughly to avoid any painful trapped wind. Thankfully reflux is a condition that smaller babies will eventually grow out of and daily tummy time will help them to reach those all important developmental milestones. If all else fails please do not hesitate to contact your pediatrician to see if medication is needed for your baby.