Silent reflux: Symptoms and treatment for babies

What is silent reflux?
Silent reflux, or laryngopharyngeal reflux (LPR), is a type of reflux where the stomach acid is brought up and then flows back into the oesophagus, irritating the larynx (voice box), the back of the throat and the nasal passages.

It is called ‘silent’ reflux because, unlike the more common reflux, there are often no obvious signs.

Silent reflux baby
LPR or silent reflux can occur in babies from about six weeks. Unlike the more common reflux, babies with silent reflux don’t usually spit up after a feed. This can make the diagnosis difficult.

It is different from gastroesophageal reflux disease (GORD), which causes irritation of the oesophagus. Silent reflux irritates the throat, nose and voice box and also sometimes the oesophagus. The stomach acid can also burn on its way back down.

It’s common in babies because their sphincters, the muscle at the top of the stomach, are not yet fully developed.

Silent reflux symptoms
While silent reflux can be difficult to diagnose in babies, there are some symptoms:

• Crying during or after feeds.
• Difficulty feeding.
• Chronic coughing.
• Noisy breathing or pauses in breathing.
• Sounding hoarse or croaky.
• Failure to gain weight.

If you suspect your baby has silent reflux, see a doctor. It can lead to complications such as ear problems, respiratory infections and damage to vocal cords.

Treatment
You can try the following tips to help manage silent reflux in infants:

• Try to keep your baby as upright as possible while feeding and for about 30 minutes after a feed.
• Try to feed them smaller amounts at a time.
• Don’t delay feeding. If your baby has been crying for a long time before a feed, they may swallow a lot of air.
• Burp them several times during a feed.
• Put them on their tummy for a while after a feed, with you supervising. Don’t put them to sleep on their tummies.
• If you’re bottle feeding, check the size of the opening in the teat. If the hole is too big the baby will drink too quickly and spit up the excess. If the hole is too small the baby has to suck very hard and will swallow air.

A doctor may prescribe medications such as H2 blockers or proton pump inhibitors to reduce the amount of stomach acid.

How long does it last?
Most children will outgrow silent reflux by the time they turn one. If children are treated promptly there will be no long-term problems, but if the delicate throat and nasal tissue are repeatedly exposed to stomach acid it can lead to problems such as chronic laryngitis and recurrent ear infections.

Silent reflux in adults
No one is sure what causes silent reflux in adults. They sometimes have heartburn and a bitter taste or burning sensation in the back of the throat but they usually don’t have these classic acid reflux signs, so, as with babies, the condition is difficult to diagnose.

Common symptoms of silent reflux in adults are:

• Hoarseness
• Excessive throat clearing
• Persistent cough
• Feeling a lump in the throat that doesn’t go away with repeated swallowing

In adults, undiagnosed silent reflux can lead to scarring of the throat and voice box, affect the lungs and irritate conditions such as asthma and bronchitis. It can also increase the risk of cancer in the area.

A doctor can diagnose silent reflux through an endoscopic exam (looking at the throat and vocal cords with a tiny camera) or pH monitoring (placing a tiny tube with a sensor in the oesophagus to monitor acid levels).

Treatment includes measures such as losing weight, quitting smoking, not drinking alcohol and watching your diet. Foods that may trigger silent reflux include chocolate, peppermint, fruit juice, caffeine, spicy or tomato-based foods and anything high in fat. Eat smaller meals more often and don’t lie down just after eating.

Adults can try over-the-counter antacids or they may be prescribed the same medication as children. Extreme cases might need surgery.

Some people swear by natural remedies for reflux and heartburn such as melatonin, calcium (the active ingredient in many antacid medications) and herbal remedies. But there isn’t enough evidence of their effectiveness and some supplements can have side effects or interfere with medications, so check with your doctor before trying any.