Suspected silent reflux at seven months; desperate to help our baby

[SilentRefluxAdvicePlease]

My daughter has slept poorly since around 4.5 months; she is now 7 months. In the last month or so her sleep has become much worse, culminating in her taking short 30 minute naps in the day, which must be in the sling, pram or car and multiple night wakings (up to ten times in recent nights). Every time she wakes in the night, the only way to soothe her is with a feed. If another settling method is attempted she cries inconsolably. Along with other symptoms, including back arching during feeds, severe hiccups at least once a day, congestion and generally unsettled behaviour, this has led me to suspect silent reflux. She rarely vomits. I approached the GP with a list of symptoms, explained my suspicions and after two appointments, she was prescribed infant Gaviscon last week. As she is exclusively breast fed and refuses a bottle, it is very difficult to get her to take it (she spits out a lot of what is in the syringe, cup or on the spoon) and so we haven’t yet seen an improvement. We have an appointment with a lactation consultant and a cranial osteopath this week to rule out feeding issues. I am looking for anyone with similar experiences, particularly of babies who were diagnosed with silent reflux after six months, to provide advice as we are exhausted (as is our baby) and desperate to help her. I am horrified to think this may have been troubling her since birth. We are coping with the night wakes by co-sleeping and I am holding her upright for as long as I can manage after feeding. Thank you.

Hi OP. Solidarity - both my babies have had reflux/silent reflux. It's a tough road, and firstly, you are doing amazingly because I am sure you are feeling exhausted.

Both my kids have had CMPA - DS grew out of it at 18 months and DD (8 months) is medicated with omeprazole to reduce the acidity. Like you, we were prescribed gaviscon first with both kids but neither would take it and if they did it just caused constipation which was as hard to deal with as the reflux. Have you considered going dairy free yourself while breastfeeding? And also for baby when weaning.

Thanks so much @Wrigglypiggly for your reply. Yes, I should have mentioned that I have cut cows milk from my diet but it hasn’t yet been a week, so I need to give that more time; three weeks at least. I haven’t given baby cows’ milk yet either, although we have been weaning her for around five weeks. Part of me is hopeful that it is the cows milk causing the issue, because relatively speaking it will be an easy fix!
Sorry to hear your babies have suffered too, it’s so hard isn’t it. Did you find their symptoms worse at night? How did you cope with the night wakings and getting them comfortable enough to sleep (assuming this was an issue for you)?

Have you cut all dairy (butter, cheese, whey etc) from your diets? Also, if it is CMPA/CMPI some babies also react to soya (similar protein chains), so if you don't see much improvement I would consider cutting all soya from your diets. Hard around Christmas time because of all the treats around but the rest of the time it's do-able.

The other thing to think about would be tongue tie - DD had a posterior tongue tie which was very subtle but meant she was taking on a lot of air when feeding which made the reflux worse, we got it snipped when she was about 8 weeks old and that helped too!

Nights are horrific with reflux babies. Both of mine were horrendous sleepers, but luckily once the reflux was under control/treated we were able to get some structure to our nights, until then I did what you are doing! I held DD basically all night while she slept which gave me horrendous anxiety but otherwise no one got any sleep. We took it in turns to get rest so I would sleep 830-1:30 and DH would give a bottle of expressed milk during that time. Then I would be with her for the rest of the night, she would never lie in a Moses basket or a bassinet, but occasionally would lie next to me in the bed.

She now sleeps all night in her own cot so I promise it is possible for things to get easier. she is still very sicky during the day, which is a pain laundry wise but she seems unfazed by it. DS had silent reflux so we were spared that annoyance

Yes, I am checking food labels religiously. If I wasn’t so desperate I would have waited until after Christmas, as I love chocolate and cheese and cream! But of course baby comes first and if there’s any chance it will help her, it’s worth it for all of our sakes.
Thank you for mentioning soya. I had heard this but haven’t yet cut it out. If after the three weeks there’s been no improvement, I’ll do another three weeks without soya to make sure.
So, tomorrow we have an appointment with a private lactation consultant. I’m nervous because I feel seven months is far too late to be diagnosed with tongue tie and I don’t know what this will mean for a potential cut. Looking back, I am half expecting it as she has always been a little and often feeder. In the early days she would feed every 30 to 90 minutes and anyone I spoke to for advice said it was normal cluster feeding behaviour, but this went on for several weeks! She has been a distracted feeder for months now but again, healthcare professionals dismissed my concerns as normal developmental behaviour and nothing to worry about, as she gained weight more or less along her curve. I just accepted this at the time but now know that silent reflux can easily not affect weight gain, as there’s no vomiting!
Thank you for sharing your experience, I now understand what it’s like to be so desperate for sleep (for yourself and your baby). I never thought I’d co-sleep but this is the reality and the only way for now. Agree, it’s completely horrific. I feel sad that for weeks I have berated myself for not enjoying the days more when actually the nights have been so brutal, it’s any wonder we’ve all been up, showered and dressed, let alone feeling up to getting out and about.
So glad to hear things improved for you. Well done for getting through and I hope your littlest one grows out of it soon too.
I’m sure I can seek more guidance on this as needed, but if you have any tips for reintroducing cows milk later on, particularly what, when and how much, I’d be so grateful!

I echo the advice above. Another mum here to a baby with CMPA, plus soya and egg. I was a vegan and so when people suggested a dairy allergy I dismissed it because I wasn’t eating dairy anyway. It was only later through trial and error on formula milks that we realised she also had a soya allergy.
What is your baby’s poo like? Does it have mucus in it? Is it a funny colour? Explosive?
I would definitely do what the others have said and try cutting dairy for 3 weeks and then soya too.
I too was feeding my baby an insane amount and could only settle her with a feed. Then I was told (could be false information!) that babies can’t tell the different between hunger pains and stomach pains so she thought she wanted feeding.
I hope you’re ok because having a baby that is constantly in distress is horrific and exhausting!

Thank you @Chocolate123456. I think I will almost certainly end up cutting out soya too.
The nappies are another thing I have been told are normal for an exclusively breast fed baby; sometimes she can go a week or more without a poo. When she does finally go it is explosive (enough to warrant throwing away her clothes). What’s interesting is that it wasn’t always like this, but I can’t pinpoint the trigger. It could have been weaning, it could have been earlier than that.
It has been a horrible journey to this point but I am now determined to get to the bottom of it. As a FTM I definitely accepted answers that I felt were not right. I essentially approached the GP with the diagnosis myself. I have been shocked by how little support there is and even less knowledge of silent reflux among the health professionals (who have all been very kind, just clearly not in the know). I also feel angry that my baby has had to put up with this for who knows how long. But that’s why our children have us to fight for them!

You're doing amazingly it's so tough when all you want is a happy content baby, and some sleep. We have also felt very fibbed off with both babies. As long as they are gaining weight the healthcare professionals kept telling us that it would get better as they got older. Which, though largely true, just makes you feel as though you should be coping with it better and that you just have to suck up the sleepless nights and the baby crying or writhing in pain! It also really tainted the baby bubble for me and led to feelings of post natal depression because I was so exhausted.

In terms of reintroducing dairy/soya down the line. I was under dieticians with my first - advised to wait until baby was 4 months symptom free before trying the dairy ladder (easily found on Google - dairy ladder and soya ladder will explain how you reintroduce foods to your/babies diet)

Also Lindt do a lovely vegan chocolate bar - salted caramel - it's delicious (I don't really like any of the vegan alternatives but this one is good!) and you deserve a treat over Christmas!!

Thanks @Wrigglypiggly, all very helpful advice and much appreciated. Will hunt for that chocolate too!

I am no help with cmpa etc but my incredibly refluxy babies preferred tummy sleeping. Could you get her over to sleep and put her down on her tummy (assuming she can roll etc). Mine slept on tummy from about 5 months. (And ever since, now 7 and 3!).

There is a decent chance she has an intolerance to something she (or you) is eating. When you see the pediatrician ask about allergy testing as well as reflux

I went dairy and soya free for my daughter on the 17th December 2020 the day before my birthday. The year before I found I was expecting on the 18th December and the pregnancy sickness started on the 23rd December so I had been really looking forward to a proper Christmas food. My partner and mother-in-law did a brilliant job of adapting the menu for me.

I would be going back for omperazole personally. Gaviscon is a such a faff to get into a breastfed baby especially an older one. We peaked at 9 sachets a day. My daughter has particularly stubborn reflux and needed the highest doses of omperazole, as much gaviscon as we could get in her and removing food from my diet. She has a lot of food allergies. This still wasn't enough and she had domperidone added. She is 3 now and still very much struggling with reflux despite highest doses of all the meds. We are awaiting a new paediatrician. Have you had a paeds referral put through? I think reflux starting after 6 months is meant to be a referral but not 100% sure on this

Thank you @Superscientist, I didn’t know that about the referral. I will ask the GP tomorrow as I am expecting them to call. I am also going to ask for omeprazole. Agree that administering Gaviscon is more trouble than it’s worth… baby swallows so much air through me trying to syringe it in her mouth, which completely counteracts any benefit anyway!
Interestingly, the lactation consultant we saw today had some useful tips. Baby has a slight tongue tie but not one that is severe enough to restrict tongue movement. She has suggested some positioning tips to see if this helps, as in addition to the tie, baby has a particularly high palate which might be causing her to swallow more air, apparently. Thanks again for your advice. It does help to know that others have come through the other side.

I thought I’d post an update here in case anyone else might find it helpful in future. The GP did prescribe omeprazole, but we never got to using it, as baby came down with a bad cough and cold and we decided to wait until she had recovered before starting it. In that time, I began to notice improvements in her silent reflux symptoms. The back arching during feeds has completely stopped. Hiccups happen much less often now and although still very wakeful at night, she is no longer inconsolable when she wakes. Aside from when she had an actual cold, she isn’t congested. She is much happier overall in the daytime and for the first time ever I was able to go out for lunch with my husband and leave baby with grandparents for over two hours! In that time she didn’t cry once; I was amazed.
There are two main things that we have tried. I have now been eating a diet free of cows’ milk for a little over four weeks. I noticed an improvement in her symptoms after one week. Around this time, we also saw a cranial osteopath and have had one further session since. So, it’s hard to know which has had the most impact, but in another couple of weeks I am going to reintroduce cows’ milk into my own diet and monitor baby. I will mention that I have cut out cows’ milk off of my own back rather than being advised by the GP, and there are several things to be mindful of, such as my calcium intake, so it’s probably advisable to seek guidance from a healthcare professional before making dietary changes (I did so much reading and am taking a good supplement, so was confident I could do it myself). Finally, baby can now sit unaided much more steadily. As she now spends a lot more time upright, I don’t want to rule out that this hasn’t helped massively too!
In terms of next steps, I am expecting the GP to call at some point in the next week or so to review the omeprazole. I will explain the above and ask for advice on reintroducing dairy into my own diet. If I remember, I will post another update in another few weeks. Thanks again to all who offered their advice, I don’t think we’d be at this point without it.

For the reintroduction wait for a good week, not teething or colds. Eat something with high levels of dairy in. A cheese sandwich yoghurt or milkshake or ice cream that sort of thing. Pick something that you have been missing just in case it's a fail. Give it 2-3 days and if you don't have symptoms try a few days of eating dairy containing foods that form part of your normal diet and see if symptoms return.

My dietician recommended a supplement with around 7-800 mg of calcium and look for alternative milks that have added iodine

@SilentRefluxAdvicePlease Can I ask for an update? We have what seems like a very similar situation - EBF 6 month old who I think has silent reflux, with congestion, some mucusy nappies, and now terrible sleep. I fear CMPA as I already don’t eat meat and will struggle for protein without dairy. But if it is, so be it! Wondering whether to try elimination or cranial osteopath or lactation consultants or GP or what. Grateful for any reports!

Hi @Oxalis00. Reading this back feels like another lifetime and in a sense, it was! In short, the biggest factor that helped us was time, which I know is very hard to hear. In time, our daughter settled and became happier and it’s hard to pinpoint one thing that helped her, but I would say, see your GP first and foremost. Go armed with any reading you have done, as I found that some GPs were not as familiar with silent reflux as others. Other things that helped us were: a) seeing a cranial osteopath and/or lactation consultant. If you feel comfortable with the idea, do your research and find someone that you trust, ideally recommended by someone you know. I found both the cranial osteopath and the lactation consultant incredibly helpful, they have seen lots and lots of babies and if nothing else, they can provide reassurance; b) learning to sit and move about more did wonders for my baby’s happiness, which of course takes time; and c) we did what we could to get sleep and that meant throwing any other sleep advice out the window. For us, this meant having our daughter in our room until she was 10 months old. She needed a lot of comfort at night and it worked best for all of us if we could give it to her quickly. She is now 21 months old and goes to sleep by herself quite happily in her own cot, in her own room, at naptime and bedtime. She has done for at least six months. For us, the period you are experiencing now was one of the most difficult of all. It improves eventually, but I used to take little comfort from people who told me that when I was in the thick of it. Finally, I would say that cutting out cows milk from my own diet did coincide with an improvement in my daughter’s symptoms. I did it for six weeks before reintroducing slowly and at this point we didn’t see her symptoms get worse again; however, I am still not convinced that the two things were linked. She now absolutely loves cheese, yoghurt and whole cows’ milk, so if she did have some kind of intolerance, she grew out of it. I hope you can get some answers but to be honest, we never did. Happy to answer any other questions you might have!

Thanks so much for getting back to me. It’s good to have some comfort from the future…! Really glad things improved for your daughter. The bit about not having answers is hard though. I do wonder about cutting out dairy but am not sure I’m convinced enough to do it properly, which means it’s not really worth doing. Did you medicate the reflux? Holding him in my arms now, on the third wake up of the night, and hate to think he’s in pain. Also frustrated that co-sleeping doesn’t help because then he takes more milk lying down which makes things worse! Sorry, rambling. Very tired….! But really do appreciate you writing back with encouragement.

I completely empathise @Oxalis00… I also wasn’t convinced by the cutting out cows milk, but I think I felt so desperate to be doing something (rather than feeling like I was doing nothing, even though I wasn’t really doing nothing because I spent so much time trying to find answers!) that I gave it a go. Sometimes I wonder if it was a little ‘reset’ for my daughter’s gut and helped in a roundabout way. But then I would have expected things to get worse again when I reintroduced cows milk to my own diet, and for whatever reason, they didn’t. I also remember trying to feed lying down which would provide very temporary relief but actually made things worse… it’s so hard. The lactation consultant we saw in late December 2023/early January 2024 suggested that my daughter had been swallowing a lot of air when feeding. This was partly due to her positioning and partly due to the shape of her mouth, essentially. So I also think tiny changes I made around feeding could have made a difference. I also keep a diary and was reading just yesterday that this time last year, sleep had started to improve for us (so within a month or two of the hardest point). Hopefully there is light at the end of the tunnel for you as you say. Everything crossed!

And to answer your question, we were prescribed infant Gaviscon initially, which was almost impossible to administer because my daughter would cry so much that she swallowed more air! Then we were prescribed omeprazole. Both medicines could be mixed with water and given by syringe (it wasn’t possible to mix in a bottle as my daughter was always a bottle refuser). I was so relieved to have the omeprazole, as I had read that it was game changing for lots of people in a similar position to us. However, we never got round to using it as we started to see improvements around the time we were ready to try it, so held off. Things continued to get better after that.

My son had silent reflux much earlier - at 2 months - but what worked brilliantly was omeprezole. You need to give it on an empty stomach - mix it in a 5 or 10ml syringe with some diluted apple juice and administer it that way.

Thank you @SilentRefluxAdvicePlease - so appreciate your account of things. It’s helpful to see that even without a clear and certain sense of what was wrong and what exactly helped things did get better. Hopefully we’ll get there soon! I am tentatively trialling no dairy and will see if it seems to be making any difference, and go from there.

@Aimtodobetter That’s good to know, thanks for the tip. I’m not sure DS’s reflux is bad enough to warrant medication, but it’s hard to compare. It also seems much more common in younger babies so I don’t know why it would suddenly get bad at 6 months? Babies are such a mystery…!

For what it’s worth I was really not keen to use the omeprazole on my baby with the whole “medication” thing but not only did it work, but during my second pregnancy I got prescribed it myself and it was just a really easy no side effects drug (which I guess is why they dole it out to pregnant women and babies).