The Symptoms of Silent Reflux

When Mason was born he was a very quiet baby. All of the nurses at the hospital made comments about how sweet and easy going he was. I remember being so proud! But once we got home, all of that changed. The sweet little angel had turned into a bundle of fury that never stopped crying. In fact, the only time he wasn't crying was when he had a bottle in his mouth. He was always ravenous and could never seem to eat enough. He also did not sleep well either. He averaged only about seven hours of sleep in a twenty-four hour period, and never more than one or two hours at a time.

My family kept telling me it was just normal baby behavior. Mason's pediatrician kept telling me it was colic. When Mason's inconsolable crying episodes reached 10 hours straight (except to eat, of course), I just knew deep down that something was very wrong. But since he was gaining weight and eating so well, much more than normal, the doctor kept telling me it was colic. I remember feeling very low at that point. I just knew that Mason was in a lot of pain, I had no idea how to stop it, and no one would listen to me. I felt like a terrible mother and even contemplated dropping him off at the hospital and leaving him. As awful as that sounds, I just felt like anyone else would do a better job and at least maybe they would be able to help him since I obviously was not able to. I just wanted my baby to stop hurting.

I started researching his symptoms online and came across Silent Reflux. Mason had many of the symptoms such as pain, poor sleeping, arching his back when eating, violent hiccups, bad breath, and gagging. So I began a journal by writing down everything for one week, what he ate, when he cried, when he slept, etc. I went back to the pediatrician armed with this information and asked him if silent reflux could be a possibility. He told me that usually reflux babies do not eat well but gave me a prescription of Zantac to try anyway. One week later I was back in his office as there had been no change with Mason. I just didn't understand what was causing my son so much pain and frustrated that we couldn't work it out.

The pediatrician ordered an Upper GI test which is an x-ray of the upper stomach. This test can sometimes show reflux, though it is not always accurate. In Mason's case, the test results showed the refluxing quite clearly. I was so relieved to at least know what was wrong. Now we just needed to find out how to help him! The pediatrician referred us to a pediatric gastroenterologist. She determined that Mason needed a different type of medicine and prescribed Prevacid. Within two weeks my son was like a completely different baby. He is still on this medication at ten months old now, and we will hopefully try to wean him off of the medicine in the next six months. But I am just so happy to have a happy, pain-free baby.

So what is Silent Reflux? Most babies are born with some degree of a reflux problem. The valve that closes to keep the food down in the stomach is not developed enough to close properly so the food comes back up. This is why so many infants spit up. Usually this is harmless and they outgrow it. But occasionally the stomach acid will come up as well. The stomach has a lining that protects us from the acid in our stomachs. The esophagus does not. When the acid washes up through the stomach, it is very painful. The most common sign of acid reflux in an infant is excessive spitting up accompanied by pain with crying.

However, a silent refluxer does not actually spit up. The acid still comes up the esophagus, but the child will swallow it back down. This can be even more damaging because instead of spitting it out, it burns both ways. Many times the infant will develop a food aversion and refuse to eat because he learns to associate pain with eating. Occasionally though you may have the opposite, as in Mason's case, an infant who comfort feeds and eats excessively. Sometimes the formula or breast-milk will coat the esophagus allowing a temporary relief. This can make diagnosing Silent Reflux very difficult. But it is important to diagnose it because over time, the acid can cause permanent scarring of the esophagus.

Some of the symptoms of Silent Reflux are:

• pain
• poor sleeping
• arching their back during or after eating*
• frequent and violent hiccups
• frequent ear infections
• refusing food despite being hungry or the opposite wanting to eat all the time for comfort
• excessive drooling
• sinus infections
• gagging and choking
• chronic hoarse voice
• apnea
• respiratory problems such as pneumonia, bronchitis, wheezing, and asthma
• gagging themselves with their fist
• poor weight gain, weight loss, failure to thrive or the opposite with excessive weight gain if they are comfort feeders
• bad breath

If you think your infant may be suffering from silent reflux, there are some things you can do. Keep a journal of everything including when he eats and how much, when he sleeps and how long, when he cries and were you able to console him, when you see him choke and how bad was it (i.e. Did he turn colors?), etc. This information can be very valuable to your pediatrician for diagnosing silent reflux..

There are some things you can do at home to help keep your infant more comfortable as well. Elevate him for at least 20 minutes after each feeding. Elevate his bed by at least 20-30 degrees as well. Thickening the formula with cereal or a commercial thickener like Simply Thick, can really help it to stay in the stomach, though occasionally this can make the problem worse so speak to your pediatrician about it.

It is very important to sit down and discuss all options with your pediatrician. There are a number of medications used to treat reflux and each child is different. One medicine may work great for one child but do nothing for the next. Reflux is also often secondary to other problems such as food allergies or motility problems where the food does not move through they stomach fast enough. In order to successfully treat an infant with reflux, it can be a bit of a guessing game. There are tests out there that can help to diagnose reflux, but none of them are 100% accurate so it can be a bit of a roller coaster ride trying to sort it all out.

And finally I would like to offer a few tips I have learned along the way. It's hard to truly describe what it feels like to have a baby screaming in your arms for hours on end and no matter what you do, you just can't stop the pain or the crying. I think the hardest lesson for me to learn was that it was okay for me to put Mason down for 15 minutes here or there while I took a sanity break. At one point I had not eaten in over a day and I was certainly in need of a shower! I finally bought a bouncy chair and would set him in it with some soft music playing while I took a shower, ate some lunch, or just stepped outside and breathed in some fresh air for five minutes. I found I was much more able to care for and cuddle Mason when I was sane! Whenever I got stressed out, he always seemed to pick up on that and would cry harder. So make sure you get those little breaks! If grandma can not come over to baby-sit, then set the baby down to get a small break. It will make things much easier.

Also, when elevating your baby, watch things like car seats. Sometimes they can cause them to hunch over and can make things worse. I bought the flattest bouncy seat at an angle I could find. There are also some wedge devices out there which can really help with elevation. Or you can simply just build your own "nest" which is what I did. Take two rolled up large beach towels and place then on the sides with a pillow at the bottom to make a "U" shape. Place this in the crib and then stretch the crib sheet over top. A 100% cotton sheet works best. This will keep the baby nested in the crib so that he doesn't slide down. You can then use blocks to elevate the top of the crib.

There are also some great support groups out there. It can be frustrating and lonesome when dealing with a reflux baby and it is nice to know there are other parents out there who can understand. Silent reflux is not easy to deal with. There are many different levels of it from mild to severe and all are difficult. Make sure you speak to your pediatrician and get some support for yourself. It is a very stressful time, but it does get better!