Do Babies Always Spit Up with Acid Reflux? Here’s What to Know!

I so seldom needed a burp cloth on my shoulder with my eldest. With my youngest, she spit up more often. But she was a happy baby despite this, and the doctor said not to worry.

Reflux and spit-up are pretty common in the first few months of life. My youngest fell into the category of what they call a happy spitter. She’d just spit up a bit and still be smiling away.

Not every baby is happy about this, though. Some babies feel great pain with reflux. So if your baby is spitting up often and seems really irritated, you’ll want to know how to help. And you may even have a baby that has all the irritations but doesn’t spit up, something they call silent reflux.

Silent reflux has all the symptoms of GERD (which I’ve discussed before), including fussy behavior and poor feeding, though it is commonly confused with colic. Normal reflux has the stomach contents coming back up and out, but it stays in the esophagus for those with silent reflux.

You don’t need to worry too much about babies with reflux since it will usually work itself out by the end of the first year. You should definitely discuss it with your doctor to see if any medical intervention is needed. When the reflux (either regular or silent) is so disruptive that it severely affects your baby’s happiness, you will certainly need to do something.

How to spot silent reflux

If your baby has silent reflux, she might not spit up after her feedings. So, if you have an irritable baby that has trouble sleeping, that’s one sign. Others include:

  • Choking and/or gagging
  • Arching back while nursing
  • Nasal congestion
  • A chronic cough
  • Won’t eat
  • Apnea and/or noisy breathing/wheezing
  • Hoarse sounds

A baby’s feeding difficulties with silent reflux can slow down weight gain or lead to weight loss. So if your baby isn’t gaining weight or even losing it, you need to have your pediatrician involved.

What causes acid reflux without spitting up?

baby spitting up

If your baby has acid reflux but doesn’t spit up, the reason may be underdeveloped esophageal sphincter muscles that open and close the esophagus. These muscles develop more as your baby grows, so it tends to resolve themselves. But still, you don’t want your baby in agony over reflux.

Babies that are more at risk for this sort of reflux are usually born prematurely; have a neurological disorder, hiatal hernia, or weak upper stomach valve; or have a family history of reflux.

How you can help your baby with reflux

In addition to working with your baby’s pediatrician, you can do a few things to ease your baby’s reflux, silent or otherwise.

Do smaller feedings more often

What’s tricky here is if you’re breastfeeding. Babies that are going through discomforts such as reflux or illness tend to nurse more to soothe the pain. But with reflux, this can make things more difficult.

Ideally, you should try to feed your baby every 2 to 3 hours when they’re awake while reducing the amount you provide per feeding. With overfeeding, there is greater abdominal pressure which can make reflux worse.

With bottles, look for bottles that have nipples with smaller holes and slow the flow. The ones that reduce air intake are best.

Hold baby upright

Especially with a reflux baby, you should use an upright feeding position. You should also maintain this upright status for about 30 minutes after a feeding to reduce those reflux symptoms.

Keep her on your shoulder or use a baby carrier to wear her in a hands-free way. You don’t want to put her in a car seat or baby chair right after feeding, as this can compress the abdominal area and lead to discomfort. And that can lead to spitting up or silent reflux.

dad pats baby back

Burp your baby often while feeding

Babies with acid reflux that don’t spit up should be burped during the feeding.

It would be best if you burped afterward, too, but doing so during it will minimize the pressure and discomfort in that tiny belly.

Look at your diet

What you eat comes through in your breast milk. Certain foods can trigger chocolate, garlic, and caffeine, while others may be food intolerances (like soy, eggs, and dairy). Watch for patterns in baby’s behavior related to what you’re eating. It may be something you’re eating that is causing this gastrointestinal distress. Be sure to give it time since some things take longer to get out of your system. Please discuss this with the doctor, too, as they will be able to help you pinpoint the cause.

Pay attention to your let-down

Some mamas may have a strong let-down with breast milk. This can make your baby choke when the milk flows too fast. Engorged breasts also pose a problem, leading to more air swallowing. If you have either of these issues, pump briefly before nursing, and it will help.

Why is my baby spitting up clear liquid?

When your acid reflux baby spits up clear liquid, please try not to panic. The clear liquid is one of the typical things you’ll see coming out though it may seem weird. I’ve written a whole post on clear baby spit-up, so check that out.

The short version of the story is that sometimes, spit-up can be clear. It can happen after burps. It can happen with reflux. It can be a part of vomiting. It could be from teething, drooling, or even an illness. Clear liquid shouldn’t be a concern unless your baby has a fever, vomiting, diarrhea, and seems ill.

Generally speaking, if your baby seems like themselves and has no fever or other troubling symptoms, an acid reflux baby spitting clear liquid shouldn’t freak you out. Of course, you can always call the doctor to have them put your mind at ease!

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