What Is Silent Reflux in Babies and How To Help

When your baby comes home from the hospital, you can feel every emotion — from joy to fear to excitement to concern. You might worry that your new baby isn’t sleeping or eating enough. What if they spit up too much? Or not at all? Reflux is common in newborns and is usually temporary, as most outgrow it by their first birthday.^1,5,16 However, some infants may experience silent reflux, which can bring back that parental anxiety. The good news? Once you know that your baby has silent reflux, there are ways you can help them.¹ In this article, we’ll explain what silent reflux looks like in babies (including its symptoms) and what to do about it.

What Is Reflux?

Reflux happens when the stomach pushes its contents back up into the esophagus. Babies spit up because the muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), is loose, doesn’t close, or opens at the wrong times.^1,2

Reflux in Babies

Spitting up is common, and most babies spit up after a meal. Whether they overeat, eat too fast, or swallow too much air, many factors can cause your baby to spit up. For example, if you bounce your baby or lay them down after a meal without burping them, the LES will likely open. This leads to food coming back up.³

If your baby doesn’t gain weight as fast as your pediatrician would like or has other concerning signs, they may check your little one for gastroesophageal reflux (GER). GER often shows symptoms like:^4,5

• Coughs or hiccups when eating
• General irritability
• Irritability during feeding
• Slow weight gain
• Spitting up or vomiting right after eating
• Swallowing or gulping around feeding

Reflux symptoms typically improve as your baby grows and their digestive system matures.^10,14,15 However, some infants may experience silent reflux, which can be more challenging to detect.¹⁵

What Is Silent Reflux?

When your baby spits up all over the place after every meal, it doesn’t take much to prompt you to call your healthcare provider. Some babies are even called “happy spitters” and spit up a lot without seeming bothered by it. But what if your baby doesn’t spit up at all or not very much? Sure, they’re a little irritable, and sure, they cough and hiccup when they eat. But those behaviors may not seem as concerning as the less-silent symptoms of reflux.

Unlike typical reflux, silent reflux doesn’t usually cause spitting up or vomiting.^5,6,15,16 However, silent reflux can still cause many of the same symptoms as its more dramatic cousin.^6,16 If you notice any reflux symptoms without spit-up, inform your provider immediately. Even without vomiting, the acid from reflux could irritate your baby’s esophagus or throat, which is called laryngopharyngeal reflux (LPR).⁷

How To Treat Baby’s Silent Reflux

Your pediatrician will examine your baby, assess their symptoms, and decide whether further evaluation or treatment is necessary. You can try the following to ease the symptoms and manage your baby’s reflux:^1,3,5

1. Adjust Their Feedings

Making minor adjustments to how you feed your baby can help reflux enormously. For example, you could try the following:

• Feed your baby sitting up: Let gravity work for you by pulling that milk away from the esophagus. Try to hold your baby still and upright for 30 minutes after feeding to give the meal a chance to settle.^16,17
• Feed your baby less, more often: Try feeding your baby less formula at a time or for a shorter time on the breast. They’ll want to eat more often, but it can be easier for them to keep smaller meals down.^15,17
• Slow down feeds: If your baby is bottle-fed, make sure you use a slow-flow nipple and only tip the bottle enough to just fill it with milk. This is called paced bottle-feeding. If you breastfeed and notice that your baby gulps a lot and sometimes even coughs and sputters when you have a fast flow, try laid-back breastfeeding or reach out to a lactation consultant.^11,12
• Burp your baby: The more you give the air a chance to work its way out, the less it will push milk up with it. Try to burp your baby more often, and see if this makes a difference.¹⁷

You know your baby best, so try a combination of the above or any ideas of your own!

2. Have Them Sleep on Their Back

You should also place your baby on their back to sleep. Although many a grandma may argue that all their babies slept on their tummies, research has proven that babies stay safest on their backs, even if they have reflux.⁸ It’s also not safe to elevate the head of their crib or bassinet more than 10 degrees, according to the United States Consumer Product Safety Commission (CPSC). In addition, you shouldn’t have any pillows or other devices in their sleep space.^13,18

3. Try Giving Them Medication

If your baby has trouble with reflux and nothing seems to be working, your healthcare provider may recommend medication for a short time. Reflux medications lower the acid level in the stomach and decrease the symptoms of silent reflux.^9,17

When To Call a Provider

Remember, silent reflux is a treatable condition. With the proper treatment, most infants with silent reflux improve and eventually outgrow it.¹⁶ However, you should inform your provider if your baby shows any of the following symptoms, according to the Mayo Clinic:¹⁰

• Blood in their poop
• Consistent projectile vomiting
• Difficulty breathing
• Lack of energy
• Not enough weight gain
• Refusal to feed
• Spitting up blood or anything that looks like coffee grounds
• Spitting up green or yellow liquid
• Start spitting up at 6 months or older
• Very irritable after eating

Silent reflux can be stressful, but with the right support, most babies improve and outgrow it. Trust your instincts, work closely with your provider, and know that better days—and happier feedings—are ahead.