Many of us will be familiar with acid reflux – an uncomfortable and painful condition where acid from the stomach travels back up the oesophagus, causing heartburn and nausea symptoms. It happens when the lower oesophageal sphincter – the ring of muscle that separates the oesophagus from the entrance to the stomach – fails to close properly, allowing the stomach’s contents to escape.
Silent reflux, which is not so widely recognised, is caused by the same physiological mechanism. Unlike acid reflux, though, silent reflux (laryngopharyngeal reflux) often occurs without such uncomfortable symptoms. This is because the stomach acid is pushed into the larynx rather than the oesophagus. Although less painful than acid reflux, chronic silent reflux can cause considerable tissue damage to the larynx, throat and oesophagus because stomach acid is extremely corrosive.
Silent reflux can be hard to diagnose, as symptoms may not be obvious or severe. However, if your child is frequently experiencing unexplained digestive problems, it is worth considering whether silent reflux may be the underlying cause. Warning signs of silent reflux include:
• A bitter taste in the back of the mouth or throat
• Breathing difficulties or asthma
• Postnasal drip
• Difficulty swallowing or sensation of a lump in the throat
• A hoarse voice
• Persistent cough
• Persistent sore throat
• Frequent burping
Young babies are especially susceptible to reflux and silent reflux as the lower oesophageal sphincter is not fully formed until around two years of age, they have a shorter oesophagus, and they spend a lot of time lying down, so stomach contents can more easily escape. Silent reflux may be a contributory factor for infants who struggle to settle when lying down or wake frequently at night with no other obvious signs of physical discomfort. Getting gravity on side by raising the head of your baby’s cot by a few centimetres can help reduce discomfort and improve sleep.
Children diagnosed with hypermobile Ehlers-Danlos syndrome, an inherited condition that affects connective tissues, may experience acid reflux and silent reflux.
To break down and absorb nutrients effectively, our bodies must produce sufficient stomach acid, digestive enzymes and bile. If any of these are in short supply, the result will be maldigestion, leading to digestive discomfort (reflux, bloating and gas, pain), malabsorption of nutrients, and ultimately imbalance in the gut microbiome. A nutritional therapist or functional medicine practitioner can work with you to identify whether and why digestive function may be compromised and give you strategies and supplements to help redress the balance and relieve symptoms.
Perhaps counter-intuitively, low stomach acid is a common feature of acid reflux or silent reflux. (So medications that suppress or neutralise stomach acid mask symptoms and cause bigger problems downstream). Betaine HCI can be taken as a supplement to increase stomach acid. For children who cannot swallow capsules, an alternative product that we like is Guttae Pepsini, a liquid blend of hydrochloric acid and the stomach enzyme pepsin.
Many children in our clinic also have insufficient digestive enzymes, meaning that food sits in the stomach and digestive tract for longer than is optimal, which can trigger nausea and reflux. One young girl I saw in the clinic recently suffered from debilitating nausea every time she ate. With the simple addition of some digestive enzymes and betaine HCl with each meal, her symptoms disappeared almost overnight, she could enjoy food again, and her quality of life improved drastically.
If you suspect your child may be suffering from silent reflux, it is important to take steps to alleviate it, as it can be very damaging if left untreated.
Eating habits, diet and lifestyle factors can exacerbate silent reflux. Here are some tips that can help to reduce or eliminate symptoms naturally.
Children may need to eat smaller, more frequent meals, so their stomach does not become too full. Leaving at least two hours between the last meal of the day and going to bed can also help so that the stomach is not over-full when they lie down to rest.
Some foods and drinks are more likely to trigger reflux or silent reflux, and these are best avoided in the evening meal or close to bedtime:
• Creamy, oily or deep-fried foods
• Alcohol and caffeinated drinks
• Citrus fruits or juices
• Spicy foods
• Carbonated drinks
Bile is produced by the liver and released by the gall bladder into the small intestine after eating. Where there is poor muscle tone throughout the digestive tract, bile can move back through the pyloric sphincter (which closes off the stomach from the small intestine) into the stomach and oesophagus. Bile-supporting supplements and foods like beetroot, celery and bitter leaves can improve bile flow and function. Try our liver cleanse juice to give your digestive juices a boost.
Sit down for meals and snacks, try not to eat too fast and chew food well. This ensures that when food reaches the stomach, the process of digestion has a head start as the mechanical breakdown of the food has already started, and the digestive enzymes in saliva have started to do their job.
When we are under stress, the sympathetic nervous system is activated: we are in ‘fight or flight’ mode. The digestive process is shut down when we are in this state because the body is literally in survival mode. When stress becomes chronic, it can really take its toll on the digestive system, and we may start to see a multitude of symptoms, including reflux and silent reflux.
To counteract this, activating the parasympathetic nervous system is essential: ‘rest and digest’ mode. When the body and mind are relaxed, the body can prioritise functions like digestion, growth and repair. Encourage your child to find activities that reduce their stress levels and help them to relax. This may include playing and exercising outdoors in nature, reading (books and magazines, not screens), or arts and crafts. Older children may find that mindfulness or breathing exercises help manage the stress response.
Magnesium is a wonderful supplement that is essential for nervous system function and can help support relaxation and digestion. It can be taken orally (magnesium glycinate is particularly good for sleep and relaxation), applied topically as a cream or spray, or added to a bath or foot soak as Epsom salts or magnesium flakes.
Postural alignment issues or low muscle tone can trigger or exacerbate silent reflux. Many babies retain tension in their bodies due to the birthing process. This can manifest as colic, fussiness and reflux or silent reflux. A paediatric osteopath or craniosacral therapist can gently release tension in the body, which can relieve symptoms even for tiny babies but also in older children, many years after the original trauma may have occurred.
Herbal teas can support digestive function and soothe symptoms of reflux. These can be served warm or cool for children and sweetened with a little honey if needed. Teas containing ginger, fennel, marshmallow, turmeric and chamomile are particularly beneficial.
To protect the mucosal lining of the oesophagus, throat and larynx when repeatedly exposed to stomach acid, slippery elm and Siberian pine nut oil can be very soothing and effective.
There are many ways to help mitigate the damaging effects of silent reflux and reduce or eliminate the symptoms that may be associated with it. But it is important first to understand the root causes so that the appropriate interventions can be made.