Silent reflux in babies: The hidden culprit behind fussiness and poor sleep

If you’re a new parent running on fumes, trying to decode every cry and wiggle, you’re so not alone. Those sleepless nights, the constant fussiness, that “something’s bothering my baby, but I can’t figure out what” feeling, it can all be a lot. And sometimes the culprit isn’t the usual suspects at all. Silent reflux (also called laryngopharyngeal reflux) can be surprisingly sneaky because, unlike classic reflux, there’s no dramatic spit-up to give it away.

To help us understand what’s actually going on, we chatted with Dr. Carey Chronis, MD, FAAP, board-certified pediatrician and founder of Dr. Carey’s Baby Care. With decades of experience guiding new parents through the wonderfully messy world of early babyhood, Dr. Carey breaks down what silent reflux really looks like, what’s normal, what’s worth watching, and when it’s time to reach out for help.

What is silent reflux in babies?

Silent reflux happens when stomach contents flow back up into the esophagus or throat, but without the classic spit-up. Babies may swallow the refluxed milk back down, making the condition harder to spot.

According to American Academy of Pediatrics (AAP), physiologic gastroesophageal reflux (GER) is extremely common in infancy. Most healthy babies experience reflux around 2–3 weeks of age, and the frequency of reflux episodes typically peaks between roughly 4 and 5 months.For most full-term infants reflux gradually improves as their digestive system matures, and many outgrow it by 9 to 12 months. Silent reflux is part of this same continuum, just less visible.

In other words, those nonstop hiccups or that little bit of snorty congestion you hear in your newborn? Totally normal. It’s often just their tiny digestive system doing its thing, even before they’re born.

What are the symptoms of silent reflux in babies?

Silent reflux isn’t the dramatic, milk-splattering kind of spit-up we usually picture. In fact, that’s part of why it’s so tricky to spot! Babies with silent reflux might seem perfectly fine one moment, then suddenly arch their back, gag, or wake up fussing, leaving parents scratching their heads. Because the classic “spit-up” isn’t always there, the signs can be subtle, easy to miss, and sometimes mistaken for just a fussy or gassy baby.

Here are some of the key symptoms of silent reflux in babies that many parents don’t immediately recognize:

• Persistent hiccups
• Back-arching during or after feeds
• “Snorty” or congested breathing
• Gagging, coughing, or swallowing sounds
• Fussiness when lying flat
• Irritability or restlessness, especially around feeds or sleep
• Sleeping in short bursts rather than long stretches
• Feeding refusal or pulling away from the bottle/breast

These little cues often line up with what pediatricians recognize as possible complications of acid reflux: trouble finishing feeds, sleep disturbances, irritability, or even minor respiratory symptoms. Noticing these patterns early can help you better support your baby, and reassure you that you’re not just dealing with a “fussy phase.”

What does silent reflux look like in babies (if they don’t spit up)?

When most parents think of reflux, they picture a baby covered in spit-up. But with silent reflux, it’s sneakier; there’s not always a big mess to tip you off. Instead, you might notice little cues that something is bothering your baby’s tummy or throat.

Here’s what to look for:

• A baby who constantly swallows or gulps during feeds – it can look like your little one is “working overtime” just to get the milk down.
• Fussiness but very little visible spit-up – crying, squirming, or arching the back can be the only hints.
• Sleep that worsens when baby lies flat – some babies get extra uncomfortable at nap or bedtime.
• Sounds of congestion or snorting shortly after feeding – reflux can travel up the back of the throat, creating those tell-tale noises.
• Frequent hiccups throughout the day – tiny hiccups can actually be a reflux signal, not just cute baby quirks.

Because these signs are so subtle, silent reflux can easily be mistaken for colic, gas, or just “a fussy baby.” Many parents don’t even realize it’s happening, which is why it can be so tricky to catch. The good news? Knowing what to look for is the first step toward helping your baby feel comfortable, fed, and sleeping a little better.

How to treat silent reflux in babies

Most silent reflux resolves naturally as the baby grows. Treatment depends on whether reflux is bothersome or painful.

This distinction is huge. Silent reflux + no pain = no treatment needed, just patience and supportive care.

Evidence-based home strategies recommended by pediatric guidelines

Medical guidance recommends first trying non-pharmacological measures, such as adjusting feeding volume/frequency, thickening feeds when appropriate, and positioning, before considering medications. 

Some practical steps:

• Offer smaller, more frequent feedings instead of large feeds.
• Burp your baby during and after feeds to release gas and reduce pressure.
• Keep the baby upright for 20–30 minutes after feeding; gravity helps digestion.
• Use slow-flow nipples or anti-colic bottles (for bottle-fed babies) to minimize the amount of air swallowed.
• Avoid immediately placing the baby in car seat or a slumped position after feeding; instead, hold them upright or gently bounce.
• Thicken feeds only if recommended by your pediatrician (some babies tolerate a small amount of rice cereal in milk/formula). As Dr. Chronis says, “thickening breastmilk or formula with rice cereal may help reduce the amount of reflux, but such treatment is often not necessary.”

Because many babies outgrow reflux naturally, guidelines often advise against acid-suppressing medicines in otherwise healthy infants, unless there are clear “red-flag” symptoms (poor growth, breathing trouble, persistent pain/regurgitation). 

When does silent reflux get better in babies?

If you’re in the thick of silent reflux, it can feel never-ending. The snorty sounds, the hiccups, the midnight fussiness, it’s a lot. The good news? Silent reflux almost always improves as your baby’s digestive system matures. Their little bodies are constantly growing and strengthening, and reflux naturally settles down as those muscles develop and posture improves.

To make the timeline clearer, here’s how Dr. Chronis, explains it: “Time is the real treatment. Between six and seven months of age, most babies are sitting up. Gravity helps reduce the reflux. By ten to twelve months of age, the muscles over the diaphragm tighten and most of the reflux is eliminated. In rare instances, reflux may persist past one year of age and may require further medical evaluation.” 

This lines up with broader pediatric guidance, according to the AAP,  reflux typically peaks around 4–5 months and gradually decreases as babies gain better head control, spend more time upright, and begin solid foods. For most full-term babies, reflux is usually a thing of the past between 9–12 months. In other words, it gets better, slowly, steadily, and often right on schedule.

Is silent reflux ever something to worry about?

Most often, no. In healthy infants without poor growth or respiratory symptoms, reflux is considered a normal part of infancy (physiologic GER). As Dr. Chronis puts it, “for most babies, having silent reflux is just part of being a baby.”

You should consider medical attention if you notice:

• Poor weight gain or feeding refusal
• Persistent, painful arching or screaming
• Forceful vomiting
• Frequent choking, gagging, or breathing difficulty

These may signal a more serious form of reflux (GERD) or another condition that requires professional evaluation.

Conclusion

Silent reflux may be a hidden culprit behind fussiness or short sleep stretches. Still, in many cases, it’s a normal, temporary part of babyhood that improves with time, simple care, and gentle adjustments. If your baby seems comfortable, is feeding and growing well, and doesn’t show worrying symptoms, often the best remedy is simply time, patience, and a few smart tweaks to feeding and positioning.

You’re doing a great job. And if you are ever in doubt, trust your instincts and reach out to your pediatrician for reassurance.

You may also like

• What I wish I had known about breastfeeding
• Baby feeding chart: A guide to year one
• The rooting reflex in babies: Their built-in GPS for milk

Sources

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2. Understanding infant reflux and GERD symptoms. HealthyChildren.org (AAP). 2023. “GERD (Reflux).”
3. Clinical guidance on gastroesophageal reflux in infants and children. American Family Physician. 2014. “Gastroesophageal Reflux in Infants and Children.”
4. Overview of gastroesophageal reflux for pediatric clinicians. Pediatrics in Review (AAP). 2012. “Gastroesophageal Reflux.”
5. Research review on infant GERD and non-pharmacological management. National Institutes of Health (NIH) / PMC.2018. “Nonpharmacological Management of Gastroesophageal Reflux in Infants.”
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7. Overview of laryngopharyngeal reflux disease in children. Pediatric Clinics of North America. 2013. “Laryngopharyngeal Reflux Disease in Children.”