Silent reflux

Silent reflux, also called laryngopharyngeal reflux (LPR), is a type of reflux in which stomach contents flow backward into the larynx (the voice box), back of the throat, and nasal passages.

The word “silent” comes into play because the reflux doesn’t always cause outward symptoms.

The regurgitated stomach content may fall back into the stomach instead of being expelled from the mouth, which can make it difficult to detect.

It’s common for babies as young as a few weeks old to have reflux. When the reflux persists beyond a year, or if it’s causing negative side effects for your child, their pediatrician may recommend treatment.

Does my baby have silent reflux?

Reflux disease is seen in about one in five children. While gastroesophageal reflux disease (GERD) and LPR can exist together, symptoms of silent reflux are different from other types of reflux.

In babies and young children, typical signs include:

  • breathing problems, such as wheezing, “noisy” breathing, or pauses in breathing (apnea)
  • gagging
  • nasal congestion
  • chronic coughing
  • chronic respiratory conditions (such as bronchitis) and ear infections
  • difficulty breathing (your child may develop asthma)
  • difficulty feeding
  • spitting up
  • failure to thrive, which may be diagnosed by a doctor if your baby isn’t growing and gaining weight at the expected rate for their age

Babies with silent reflux may not spit up, which can make it difficult to identify the cause of their distress.

Older children may describe something that feels like a lump in their throat and complain of a bitter taste in their mouth.

You may also notice hoarseness in your child’s voice.

Reflux vs. gastroesophageal reflux disease (GERD)

LPR is different from GERD.

GERD primarily causes an irritation of the esophagus, whereas silent reflux irritates the throat, nose, and voice box.

What causes silent reflux?

Babies are prone to reflux — be it GERD or LPR — because of a number of factors.

Babies have underdeveloped esophageal sphincter muscles at birth. These are the muscles at each end of the esophagus that open and close to allow for the passage of fluid and food.

As they grow, the muscles become more mature and coordinated, keeping stomach contents where they belong. That’s why reflux is more commonly seen in younger babies.

Babies also spend a lot of time on their backs, especially before they learn to roll over, which may happen between 4 to 6 months of age.

Lying on the back means that babies don’t have the benefit of gravity to help keep food in the stomach. However, even in children with reflux, you should always put your baby to bed on their back — not their stomach — to reduce risk for suffocation.

The mostly-liquid diet of babies can also contribute to reflux. Liquids are easier to regurgitate than solid food.

Your baby may also be at an increased risk for reflux if they:

When to seek help

Most babies can thrive despite silent reflux. But seek medical attention if your child has:

  • breathing difficulties (for example, you hear wheezing, notice labored breathing, or your baby’s lips are turning blue)
  • a frequent cough
  • persistent ear pain (you might notice irritability and tugging on the ears in a baby)
  • feeding difficulty
  • difficulty gaining weight or has unexplained weight loss

What can I do to manage or prevent silent reflux?

There are several steps you can take to help reduce reflux in your child.

The first includes modifying your diet if you’re breastfeeding. This can help reduce your child’s exposure to certain foods they may be allergic to.

The American Academy of Pediatrics (AAP) recommends removing eggs and milk from your diet for two to four weeks to see if reflux symptoms improve.

You might also consider removing acidic foods, like citrus fruits and tomatoes.

Other tips include:

  • If your child is drinking formula, switch to a hydrolyzed protein or amino-acid based formula.
  • If possible, keep your baby upright for 30 minutes after feeding.
  • Burp your baby several times during a feeding.
  • If you’re bottle feeding, hold the bottle at an angle that allows the nipple to stay full of milk. This will help your baby to gulp less air. Swallowing air can increase intestinal pressure and lead to reflux.
  • Try different nipples to see which one gives your baby the best seal around their mouth.
  • Give your baby a smaller volume of food, but more frequently. For example, if you’re feeding your baby 4 ounces of formula or breast milk every four hours, trying offering 2 ounces every two hours.

How to treat silent reflux

If treatment is needed, your child’s pediatrician may recommend GERD medications, such as H2 blockers or proton pump inhibitors, to help reduce the amount of acid made by the stomach.

The AAP also recommends the use of prokinetic agents.

Prokinetic agents are drugs that help increase movement of the small intestine so stomach contents can empty faster. This prevents food from sitting too long in the stomach.

How long does it take for silent reflux to resolve?

Most children will outgrow silent reflux by the time they turn one.

Many children, especially those who are promptly treated with at-home or medical interventions, have no lasting effects. But if delicate throat and nasal tissue is frequently exposed to stomach acid, it can cause some long-term problems.

Long-term complications for persistent, unmanaged reflux may include recurrent respiratory problems like:

Rarely, it can lead to laryngeal cancer.

Should I be concerned about my child’s reflux?

Reflux, including silent reflux, is extremely common in babies. In fact, it’s estimated that up to 50 percent of infants experience reflux within the first three months of life.

Most babies and young children outgrow reflux without any lasting damage to their esophagus or throat.

When reflux disorders are severe or long-lasting, there are a variety of effective treatments to get your child on the road to a healthy digestion.