SILENT REFLUX

RMacLean
January 2005

Silent GER refers to GER or GERD without any outward or typical symptoms.  This could mean that a child isn't vomiting or appearing uncomfortable but is having reflux episodes.  Some children may swallow the refluxed material (refluxate) back down instead of throwing it up, in some kids it may not come up enough to actually come out the mouth.  This can be much more difficult to diagnose, since the most common symptoms are not present.  It can also be more damaging as the refluxate burns the esophagus on the way up and again on the way down.  Whether or not the silent reflux needs to be treated depends on the complications that are arising from it.

Some symptoms that can indicate silent reflux are:

• irritability and pain
• poor sleep habits typically with frequent waking*
• arching their necks and back during or after eating*
• frequent hiccups*
• frequent ear infections
• refusing food or accepting only a few bites despite being hungry* or the exact opposite requiring constant small meals or liquid
• food/oral aversions
• anemia
• excessive drooling
• running nose, sinus infections
• sinus congestion
• swallowing problems, gagging, choking
• chronic hoarse voice
• frequent red, sore throat without infection present
• apnea
• respiratory problems—pneumonia, bronchitis, wheezing, asthma, night-time cough, aspiration
• gagging themselves with their fingers or fist (sign of esophagitis)
• poor weight gain, weight loss, failure to thrive*
• erosion of dental enamel
• neck arching (Sandifer's Syndrome)
• bad breath

As with regular reflux, the child does not need to exhibit all the symptoms listed to have silent reflux.  If you believe your child has silent reflux, start with lifestyle modifications as suggested in the article on 14 Steps for Helping a Baby with Reflux.  If this is not enough to help, you may need to bring baby to the doctor as the next step may be medications. The treatments page will give you a list of the medications used to treat reflux.

Usually the doctor will not order any diagnostic testing to confirm reflux is present unless it does not respond to initial treatment. If it continues despite medical therapy and begins to cause more serious complications, the doctor will likely begin further work ups.

* denotes most common symptoms of silent reflux

Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine