What is SILENT REFLUX? (And what can you do about it?)
ฝัง
- เผยแพร่เมื่อ 6 ก.พ. 2021
- So what is "SILENT REFLUX"?
What if I told you that the Royal Children's Hospital in Melbourne states that "[Silent Reflux] is not a medical diagnosis. The term is very controversial as there is no scientific evidence to support this."
Silent reflux is certainly controversial, and that's all well and good, but what is it?
Essentially, "silent reflux" is reflux without the vomiting. Some babies vomit as a part of a normal process, some because of allergy, some because of other reasons.
In this video I discuss some of the causes, as well as some of the options available for those who think their bub has a bit of silent reflux going on.
REFS:
1. Faubion WA, Zein NN. Concise Review for Primary-Care Physicians Gastroesophageal Reflux in Infants and Children. Mayo Clin Proc. 1998;73:166-173. doi:10.1016/S0025-6196(11)63650-1
2. Jeurink P V., Knipping K, Wiens F, et al. Importance of maternal diet in the training of the infant’s immune system during gestation and lactation. Crit Rev Food Sci Nutr. 2019;59(8):1311-1319. doi:10.1080/10408398.2017.1405907
3. Molina-Infante J, Bredenoord AJ, Cheng E, et al. Proton pump inhibitor-responsive oesophageal eosinophilia: An entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut. 2016;65(3):521-531. doi:10.1136/gutjnl-2015-310991
4. Ciciora SL, Woodley FW. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux. Pediatr Drugs. 2018;20(6):523-537. doi:10.1007/s40272-018-0311-3
5. Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy. - Choosing wisely. www.choosingwisely.org.au/rec.... Accessed February 6, 2021.
6. Kids Health Information : Reflux (GOR) and GORD. www.rch.org.au/kidsinfo/fact_.... Accessed February 6, 2021.
7. Clinical Practice Guidelines : Gastrooesophageal reflux disease in infants. www.rch.org.au/clinicalguide/.... Accessed February 6, 2021.
8. Hiscock H. The crying baby BACKGROUND. Aust Fam Physician. 2006;35(9):680-684. www.cyh.com/cyh/phl/phl_index.stm. Accessed February 6, 2021.
9. RACGP - Feed thickener for infant reflux. www.racgp.org.au/clinical-res.... Accessed February 6, 2021.
10. RACGP - Gastro-oesophageal reflux in children - what’s the worry? www.racgp.org.au/afp/2012/may.... Accessed February 6, 2021.
11. Malchodi L, Wagner K, Susi A, Gorman G, Hisle-Gorman E. Early acid suppression therapy exposure and fracture in young children. Pediatrics. 2019;144(1). doi:10.1542/peds.2018-2625
12. Smith CH, Israel DM, Schreiber R, Goldman RD. Proton pump inhibitors for irritable infants. Can Fam Physician. 2013;59(2):156. www.pretx.org. Accessed February 6, 2021.
13. Bjornaes KE, Elvbakken G, Dalhoi B, et al. Osteopathic manual therapy (OMT) in treatment of gastroesophageal reflux disease (GERD). Clin Pract. 2019;16(3):1109-1115. doi:10.4172/clinical-practice.1000453
14. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN. 2018;66:516-554. doi:10.1097/MPG.0000000000001889
15. Leung AKC, Hon KL. Gastroesophageal reflux in children: An updated review. Drugs Context. 2019;8. doi:10.7573/dic.212591
16. Ciciora SL, Woodley FW. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux. Pediatr Drugs. 2018;20(6):523-537. doi:10.1007/s40272-018-0311-3
Loved this video. You explain this much better than any Dr. I have heard. Thank you!
Thank you very much for your kind comment! I hope it has been helpful for you 😊
Love your act of the “thing”, as if you’ve met our daughter!
I've seen it once or twice before!! Hope the information helps you and your daughter.
Thank you again for the straightforward explanation! I like that you also add resources in your videos. 😁
You're very welcome! Thank you for the positive comment!
Excellent video
Thank you very much! Excellent comment! :D
We found the product called Colic Calm, a natural product made of organic coal to be very helpful. It also has no side affects.
Thank you for your comment Jenny. I will admit I am not familiar with this product (which doesn't surprise me - there are SO MANY out there), but I will certainly look for research backing it up. At first glance, the ingredients certainly do focus on gut happiness, which in turn could influence that behavioural side of things. Certainly worth investigating!
Hi I've just bought the colic calm, please could u tell me, did it prevent baby from vomiting, how did it make a difference N how much N how often did u gv the infant.. Thanks
My baby just tried it and actually threw up after every feeding . He had spit ups but for not full vomits until this product. I know it works for many other babies though.
Has this hasn’t worked for my baby either… on to the next product 😞😩
Hello Dr Christian, I have done an endoscopy and its been determined I have hiatal hernia. A couple weeks ago, I discovered I have LPR symptoms. MY GI would like to do another endoscopy.
I was wondering with diet and perhaps stretching out the stomach muscles, i.e. can the symptoms go away in time?
Hi William - thanks for reaching out.
A hiatal hernia certainly can contribute to reflux symptoms. Unfortunately, my knowledge in this area regarding stretches for hernia is limited, however from what I recall on the subject stretches may be able to ease some of the discomfort you're experiencing. I'd also consider having a look at your diet and seeing if there is anything sneaking in that might be creating some issues as well.
I am curious as to why another endoscopy, but I'm sure the GI has reasons...
Hi Dr Christian, thanks for educating us with this video. My baby is already on omeparazole and A2 protein mill which is easier to digest but still gets unsettled in the afternoon and squeals at night. She's turning 8 months in few days, I was hoping that this should be settling as she nearly standing by herself. What can you recommend?
Hi there!
Thanks for reaching out, and the lovely comment. While A2 is easier, it does still contain beta-casein (albeit the A2 beta casein) which we can still react to. If it is worsening over the course of the day, it could be a case of accumulating over the day. Are you giving A2 milk or formula?
I'd also have a look and see if anything else may be creeping in - cheeses, yoghurts, and creams can also flare things up!
My baby is almost 5 months old, she is supposed to be eating 5-6oz each feeding, she always eat only 3oz and take a 15-20 minute break and then maybe finish the feeding after that (takes up to an hour to feed her sometimes) Not sure if she has silent reflex, could be the whole milk formula ??
Hi I've had with previous 2babies,n they would be miserable N just cry N cry, I could actually hear the acid bubbles in their throat N it usually used to go back down and they could never sleep on their backs, always raised to the point where they were almost sitting or on their tummy I used to see them find comfort.. My paed suggested eliminating foods which I did, didn't help, n also I tried nexium which aggravated it, then I used to gv a teeny amount of bonnisan before feeds to help baby burp easier, n also colic calm in the eve when it was v bad.. I'm experiencing it again now with my 2month old, n it stressful as they don't sleep well, n neither does mom, n u always worry about them choking on spit up.. Please suggest if u know what else we could try.. It's so bad, u can't change a Nappy except that they spit up milk N choke...
Hi there Shaakira, and thanks for your comment.
This sounds like a rather unpleasant process that you have gone through. I do have some questions:
- What foods were recommended to avoid?
- How long did you cut them out completely for?
- Have you tried probiotics?
Thanks for the video Dr Christian, my baby is already 14 months old and still has it, she now doesn't cry from pain but asks for more food and runs around like sth is bothering her (refuses to sit down and just literally runs from one side of the apartment to the other till she burps) is this an improvement considering that she's not crying? Our GI dr says we should just wait but never has done any tests. But why is it not going away or is it? :(
Hi Janna - thank you for the comment!
Unfortunately, just because she isn't crying doesn't mean that she is necessarily getting better, she could just be getting used to it. Are you noticing it happens more with a particular food?
At 14 months it can be tricky to test for things like allergies, but you could certainly do food exclusions and see if behaviours start to improve.
Look forward to your response!
@@AskDrChristianthanks for your reply ☺️ I have tried excluding certain foods but i didn't seem to see a difference. We also gave her Neocate for the last 5 months to exclude cow milk protein allergy. Do you have more suggestions? We are going to do manual therapy in a month although we did when she was 3 months of age.
And have you heard of such a behaviour, that reflux could cause her to run around the house and not want to sit down? What do you suggest we can do? I'm really tired and worried about her :(
Hi again Janna - and sorry about the delay in my reply.
So to be on Neocate means that you have seen a paediatrician, which is good as this means the more serious possibilities have likely been ruled out.
You are going for a trial of manual therapy? That is good to hear. Where in the world are you? And what are you going to get done?
As for the running around behaviour, yes I have seen that in two other situations; kids with sensitivities to additives/colourings (so usually a bit older), and kids with parasites. Both of these could come across as a sensitive tummy kid.
So which foods did you exclude, and for how long?
What were your vitamin D levels during pregnancy?
Did you do exclusive Neocate or were you breastfeeding at the same time?
@@AskDrChristian could you please send me your email? I can explain to you our story and maybe you can help me with eliminating some food :)
Of course! askdrchristian@gmail.com
Hi dr
Do you recommend giving the 2 weeks old probiotic? For acid / silent reflux
Hi there Hamna,
The first thing I would be doing is ruling out the serious, then look at diet and musculoskeletal system. Many things can cause reflux, and probiotics may be one avenue to help.
If you are concerned whether 2 week old can have probiotics, if you are breastfeeding you can take the probiotic and the bacteria can be transferred via the breastmilk.
What About using nat phos for a 3 month old?
Do you think that helps because of the cell salts?
You know what, I used to use tissue salts/cell salts quite often when I worked with grown ups, but it is not something that I use often in babies! So I'm very sorry, but at this point I couldn't tell you if it works, how it works, or even if you should be using it for that age.
However, you have piqued my interest... I'll be sure to have a look!
Thank you!
I'm using this for my two month old, a few days in and it seems to be helping truly
Dr I have the exactly same symptoms, and while fasting in Ramadan the problem disepears like magic!! I feel my throat and my voice are very clear, but when I come back to the ordinary days it just come back 😥😥
This likely means its something you are eating!
@@AskDrChristian Thank you Dr Christian
Hi Doctor, My 3 month old is suffering from Silent Reflux and the paed said it has turned out to be severe GERD. PPIs did not work on my baby he has following symptoms please suggest what can be done..he is active when not sleeping, and a happy baby otherwise, he is 13 lbs. It hurts to see him in discomfort and restless.
1. He keeps squirming or squealing in sleep and arches his back
2. He swallows the milk coming up in his throat
3. Constantly tries to keep things down my pushing and grunting and making movements and arching back
4. He mostly turns towards his rigt side
5. Feeding issues, he starts ro choke or gag while feeding
6. He is on breastfeeding from his birth, it was a normal delivery
7. He is gassy and his abdomen keeps making sound
8. Has very disturbed sleep, he needs a pacifier and likes to be held and swinged sideways. Only then he sleeps
9. Doctor said it is cause of overfeeding but i have heen seeing his symptoms from early stage
10. uncomfortable lying on flat surface, keeps squirming
11. He drools a lot with bubbles
I do not take any milk since it creates bloating to me, I have limited or stopped any milk products since I am breastfeeding. I eat wheat, rice, dal and sometimes chicken and egg, I drink Alkaline RO Water, taking Calcium and D3 supplement called Vehycal. He drinks milk only for 10-15 mins and thus I feed him every 2-2.5 hours. Nights it becomes 4-5 hours gap.
My 5mo has exact same symptoms
Same here with one month baby
Any solution? I’m facing the same issue
Very interesting. Silent Reflux (or LPR/Laryngo Pharangeal Reflux as its starting to become known as) is a bit of an interesting one. So often it is driven by allergy processes, with cows milk being the #1 trigger. In some kids, a complete cessation of dairy product is needed for at least 2-4 weeks to see any change - because just a single teaspoon of dairy product in your diet can trigger the responses!
The next most common reason is coordination or control over the structures involved with swallowing. Musculoskeletally, we find problems in the neck may affect the ability to properly coordinate swallowing. And the real kicker here is the SAME NERVE that is involved with a lot of swallowing activity is involved in keeping stuff in your stomach!
Has your bub had any other assessments done?
Dr says my cough is possible silent reflux. On 3rd day of meds. But not working yet
Cough certainly could be a sign of just good old regular reflux. Silent reflux is not actually a medical condition!
Would need to look more into what could be going on there, as it can be anything from cilia dyskinesia to allergies to just too much mucous being produced! Even your diet could play a role in this.
Meds should have started showing some improvements though... Maybe a chat with your doctor again soon hey?
My 8 month old has severe coughing fits both day an night I keep her upright all day long smaller feeds ect doc says reflux but she’s had this 7 weeks old she’s on gaviscon has been for over a month it’s not helped is this definitely reflux??
She also has cmpa and is on hydro formula already
Hi Naomi, thanks for the message.
Hmm. This is starting to look more like a condition like GERD/GORD, where some of the stomach content is going up and into the lungs. If Gaviscon hasn't had much help, and you have a diagnosis of CMPA, then I'd be wondering what else is going in? Has she started any solids? Are you breastfeeding as well? And which formula?
This might be a time to chat to your paediatrician as having this for 6-odd months is quite a long time...
Let me know how things come along!
@@AskDrChristian hi dr! Thank you for your advice I have now got 2 referrals for a dietitian and an allergy specialist too
@@AskDrChristian we’ve also been prescribed omeprazole which seems to be helping
Great to hear! I'd now be looking very closely at a potential of "Eosinophilic Esophagitis" - of which there is a subtype with is called "PPI responsive". A lot of research seems to show that when reflux medication works, its not for the reasons we think and this condition is one of the reasons why. Plus it could also fit your presentation!
Hello Dr. Christian, we have 2 month old baby which has what we think is "silent reflux".
It's verry tough since she has a lot of pain and hysterical cries when is a feed time and also disrupted sleep.
We tried with siryps but doesnt help.
You may need to look at your diet! It can take 2 weeks for aggravating substances to get out of breastmilk, and then a further 2 weeks to get out of bub!
@@AskDrChristian Thanks for the reply!
I forgot to mention that she is on formula, not brest feeding. What can be done in that case ?
Hi there!
So in that case you will need to look at the ingredients of the formula. Some formulas may be listed as being "hypoallergenic" or "cow's milk protein free". You may need to change formulas to help, but this is best done with some proper guidance by a health care professional.
@@AskDrChristian thanks for your feedbak we will do so. Wish you the best !
Is manual therapy same as chiropractic treatment?
Great question!
Manual therapy is the global term used to describe what chiropractors, osteopaths, physiotherapists and the like use. When a chiro does their treatment, it is manual therapy. The challenging part is some practitioners/professions use slightly different terms to describe what they are doing, and there is quite a variety in what can be defined as "manual therapy".
Hope that helps clear things for you!
Christian
Sir my baby had nasopharyngeal obstruction 2 tiems because of silent reflux during sleep. I was really scared. Now I am observing 24/7.Plesse help me
Hi there Fahreen, and thank you for reaching out.
Obstruction sounds very scary when it occurs, and this is one of those situations where working with your health professional is very important. Reflux can increase the risk of this obstruction occurring, so we need to look at how we can address this. There are a couple of options:
- Consider use of medication, as there are a few studies that show taking medication may improve things
- Address any mechanical/muscoloskeletal issues that may be compromising the muscle function at the stomach, and
- Address any dietary components (could there be a cow's milk or other food protein allergy occurring) that may be contributing to the reflux as well.
All the best, and I hope you find a solution!
Thank you sir
Hi dr, my twins were 25 week preemies and now home 3 months adjusted. My question is one twin is having trouble with his feeds. He starts to choke while feeding and sounds like he gets flem build up and gargling noises. He has good days where we can finish 3oz n other days he starts to choke with every few drops. Wonder if you can help
Hi there - and sorry about the delayed response!
Do you find he's worse on one side compared to the other? The congestion can be mucous being produced, but the choking sounds more like a coordination issue - this is something I usually see becoming an issue in babies with musculoskeletal issues. Could be worth getting your bub checked by a musculoskeletal practitioner like chiro, osteo or physio 🙂
The only think that sorts it for me Is esomerprazole, every food gives it me
Thats not ideal! But at least you have found something that helps!
What exactly is manual therapy?
That is a GREAT question! In fact, it is so great, I'm going to make a video explaining this!
In a nutshell, "manual therapy" is any form of physical therapy that invovles using our hands or a tool to apply a force for therapeutic effect. Now, this might vary a bit between practitioners, as it can go from light pressure for cranial work for instance, to a bit more pressure for mobilisations or manipulations. I'm actually about to hit submit on a paper discussing these forces for publishing as well!
And for reference, the amount of force we typically use is around 15-40N; about what you do when testing if an avocado is ripe :)
@@AskDrChristianHi Doc, I’ve been having a lot of issues with post nasal drip that won’t go away and my dr told me over email that I most likely have LPR! Any advice? I hope I don’t have it but my Dr said there’s really no way to confirm if I have it. Sounds strange to me
Hi
my baby is gagging after he eats, 20 day he was fine and suddenly he is gagging and sometimes spit up or even throw up! and after he eats he its crying and it looks like he is in pain and disu 😞 is this silent reflex? dr suggest formula AR!
Hi Athina - thank you for your question. There are a few more points we need to clear up:
- How old is your bub? Just on 20 days (so just around 3w old?)
- Is he breastfed as well?
- Was he on a different formula previously? Which one?
- Are you noticing any other unusual patterns; is he preferring to face one side, or having some trouble getting his head/arms through his clothes when getting dressed?
- How is his skin? Any cradle cap or dry patches/rashes?
- And how is his poop? Any signs of stringiness or slime-iness, or mucous present? Does he strain or push a lot to get it out?
AR formula is designed to be a bit thicker and keep things down that way, but unfortunately, it usually contains ingredients that make babies unsettled or vomit!
Sudden onset changes like that always raise my concern levels a bit. I will be able to guide you a bit better with a bit more information. You are welcome to email me privately at askdrchristian@gmail.com
@@AskDrChristian i was giving him
also my milk but i dont have any more he is 1 month now! i started noticing this things after 21 days. i was giving him since yesterday the frisolac formula, his skin is fine also hes reflections! for example i fed him the ar formula and after one hour he vomit and smell like acid and he was very uncomfortable, also i wait 30 minute before i put him on his crib! and you can see from
his face that he is struggle 😞 and everyone sais its normal and im over reacting
and also he dont like to be on his back he is sleeping better one the one side, but the difference he is not crying all the time he is very quiet! and sleepy baby! only when he eats, some time its only gagging and he is going back to sleep, or like last night he was suffered for one hour until he throw up and i made him some tea because i smell the acid and i wanted to smooth hes throat! this is happening for 5-6 days now
Hi again Athina,
Thank you for the extra information. I would consider a change in formula with some of these signs. I'm not familiar with the brand Frisolac, but a quick look shows they have an "HA" option (Frisolac Gold HA Stage 1). HA stands for hypoallergenic, and this can be quite useful for kids showing signs of cow's milk allergy.
Best bet though is to have a chat with your health professional about this change, as the last thing you want is for him to be uncomfortable feeding!
@@AskDrChristian an other question 🥰 is it possible after 20 days of drinking cows milk and i everything is fine the baby suddenly appears allergy symptoms? or just vomiting?
I thought I have angina or asthma ( at last pneumonia) . Done EKG echo . Nothing wrong with heart. Than later I had feeling tightness during swallowing and like something is stucking in my throat.Now I connect it possibly with so called " gerd" . But stomach is last thing I would thing about as a cause. Should I do gastrostopy or what?
Hi Peter - thanks for the message.
If its been going on for a while, it might be smart to chat to your GP about getting an endo done, but ultimately something is going in that is creating the problems, so a chat to a dietician/naturopath may be help ful as well.
Christian
I get severe burning in my chest can’t breath and now lost of smell and burning throat
Hi Sergio - time to go see a GP!
I had all that for years after having my gallbladder removed, I then started drinking alkaline water and I don’t have it anymore, a GP will only give you dangerous ppi medication
Hi I am from Pakistan.... My baby is 20 months old and he has a reflux problem I treat it alot but no cure so kindly help to take out my baby in pain he. Is still vomiting
Hi there Abdul from Pakistan!
How long has he been vomiting? What has he been eating? What treatments have been done?
There are a lot of variables that can really influence your baby's behaviours! If this is a concern that has been going on for a long time, it may be more beneficial to have someone local review your bub and make sure everything is OK!
(If it helps, the first thing that came to my mind was a condition called FPIES - vomiting/diarrhoea from various food sources)
Thanks!
Christian
Was that a fart logo? 💨
;)