Silent Reflux in Babies

23 Dec

Silent reflux is not a formally recognised term in the medical literature, but it is commonly used among parents visiting our Allergy clinic. The term Gastro-oesophageal Reflux/Disease is more widely used, but regardless, parents use these terms to describe ‘silent, i.e. without visible regurgitation, symptoms that may include:

Feeding refusal
Irritability (especially during or after feeds)
Back arching
Choking, gagging, or coughing and may smell of sick when this happens
Unexplained or inconsolable crying

Severe Findings

While less common, some infants may also experience:

Food/feeding refusal
Hoarseness or a chronic cough
Respiratory symptoms such as wheezing or recurrent pneumonia
Growth faltering or "failure to thrive" (in more severe cases)

What Is Silent Reflux?

Silent Reflux Babies — CMPA baby symptoms

Frequently Asked Questions

- Feeding refusal
- Irritability (especially during or after feeds)
- Back arching
- Choking, gagging, or coughing and may smell of sick when this happens
- Unexplained or inconsolable crying
Severe Findings
While less common, some infants may also experience:
- Food/feeding refusal
- Hoarseness or a chronic cough
- Respiratory symptoms such as wheezing or recurrent pneumonia
- Growth faltering or "failure to thrive" (in more severe cases)
- The first-line therapy is parental reassurance and conservative measures.
- These include feeding modifications, such as smaller, more frequent feeds and, in formula-fed infants, thickened feeds.
- Extensively hydrolysed or amino acid-based formulas may be considered for infants with suspected cow’s milk protein allergy. Hydrolysed rice milk formula is also a good choice, thought to be more palitable.
- Maternal elimination of dairy may be trialled in breastfed infants. The major Allergy Societities discourage this but many parents hae already trialled dietary eliminations before attending clinic. In our expeience, some babies will be more comfortable with maternal dietary modification, but this needs to be monitored by a Dietitian.
- NB! Positional therapy is not recommended due to safe sleep guidelines.
- Pharmacological treatment (H2 blockers or PPIs) is reserved for infants with confirmed GORD who do not respond to conservative measures and have significant symptoms or complications.
- Acid suppression does not stop the mechanical propcess of vomiting, but will reduce pain and acid irritation, which itslef may calm the mucosa and nerves down in an irritated oesophagus.
- Acid suppression should be used for the shortest duration possible (typically 4–8 weeks)
- Acid suppression is not adequate for non-acid reflux and carries risks, including infection and altered microbiome with possioble links to subsequent allergy development.
The following "alarm symptoms" are not typical of silent reflux and warrant urgent evaluation for alternative diagnoses:
- Bilious (green) vomiting
- Hematemesis (blood in vomit)
- Persistent, forceful vomiting
- Important: Growth faltering should always prompt further evaluation for underlying pathology.

Worried About Allergies? Let’s Help You Get Answers

If your child is showing signs of a food, pollen, or skin allergy, early diagnosis is key. At London Allergy Consultants, our expert team provides trusted, evidence-based care tailored to your child’s needs. From testing to treatment plans, we guide you every step of the way.

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