How are Baby Reflux, Silent Reflux and CMPA "Officially" Diagnosed?

I regularly get asked how baby reflux is actually diagnosed. The truth is that there are no proper guidelines for “diagnosing” reflux. Here, I explore this in more detail and help you with what to do next if you believe your baby has reflux.

What are the different reflux diagnoses?

Firstly, let me start by saying that there are multiple formal diagnoses that your baby may receive for reflux. These include:

• gastro-oesophageal reflux (GOR / GER) for reflux
• gastro-oesophageal reflux disease (GORD / GERD) for reflux
• laryngopharyngeal reflux (LPR) for silent reflux
• extra oesophageal reflux (EOR) for silent reflux

Lots of long names for the same thing: regurgitation.

Some babies, like my own daughter, get described as being colicky, with no official diagnosis at all.

However, when they don’t “grow out of it” by the magical 12-week mark, the diagnosis often gets upgraded to reflux.

The difficulty, in truth, and according to the 2018 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 (a.k.a. the medical experts), is that…

“Symptoms of GERD are known to vary widely by age and are non-specific. As a consequence, proving that reflux events cause one or multiple symptoms is often difficult (1,12). This is particularly true in nonverbal infants in whom defining troublesome is problematic. Reported symptoms of infant GERD vary widely and may include excessive crying, back arching, regurgitation and irritability. Many of these symptoms, however, occur in all babies with or without GERD, making a definitive diagnosis challenging.”

On a side note, I don’t think that it’s at all difficult to define a “troublesome” symptom in a nonverbal infant. Just because they don’t use words does not mean they are not able to communicate with us! 

Back to the question at hand… how is baby reflux diagnosed?

As the medical experts rightly point out, the symptoms in infants with reflux (and this includes all variations you might see of reflux, silent reflux and colic) vary widely.

In fact, in taking a holistic approach, we look at over 80 different symptoms, behaviours and patterns of these in every child. And this is a part of the problem.

You see, reflux is not actually a disease, and this is why it does not have its own unique set of symptoms that present every time. Reflux itself is a symptom.

And it is by reframing it that we start to understand it much better, much quicker, and we can take much stronger, swifter action to resolve it.

If you feel that your baby is upset, unsettled, cries a lot, or brings up feeds frequently, you may or may not get a diagnosis of reflux from your health visitor, midwife or doctor.

There are no proper guidelines for “diagnosing” reflux. The recommendations referred to above (you can access the full document here) suggest using the symptoms listed in this document, which are few in number and ignore much of what we really need to be looking for.

Symptoms and signs that may be associated with gastro-oesophageal reflux disease in infants and children:

• Discomfort/irritability
• Failure to Thrive
• Feeding refusal
• Dystonic neck posturing
• Sandifer's syndrome
• Recurrent regurgitation with/
  without vomiting in the older child
• Hematemesis
• Dysphagia/odynophagia
• Wheezing
• Stridor
• Cough
• Hoarseness
• Dental erosion
• Anaemia
• Esophagitis
• Oesophageal Stricture
• Barrett's oesophagus
• Apnoea spells
• Asthma
• Recurrent pneumonia associated with aspiration
• Recurrent otitis media

The guidelines also provide some Red Flag Symptoms that may not be related to reflux for practitioners to look out for a differential diagnosis.

However, suppose you compare the list of symptoms above to the list of symptoms and behaviours that we look at for a holistic understanding of what is going on for every child. In that case, you will see that there is a lot that is being ignored by the medical world. You can download this list of symptoms in our free symptoms tracker.

So, how is reflux officially diagnosed?

Well, there is no strict set of symptoms to allow for reflux to be easily diagnosed.

If a parent describes a baby as upset a lot with a lot of vomiting and spit up, this can be enough for one doctor to diagnose reflux, while another in the very same practice might just say, “That’s just spit up”.  

A parent might describe a baby as being particularly unsettled all the time and never happy with some feeding troubles, and this might be enough for one doctor to diagnose reflux. At the same time, another might simply say, “All babies cry”.

And what are you to do when there is all this lack of clarity about it?

Trust yourself.

If you believe your baby is more unsettled than they should be, if you think they are telling you that they are uncomfortable or in pain, then this is enough to want to do something about it.

We don’t need to have a formal diagnosis of reflux from a doctor to take action.

Start with our symptoms tracker, if your baby has three or more symptoms or behaviours on this list consistently or regularly, and you feel they are more unsettled than they should be, then we can do something to support them to be more comfortable in their body.

They deserve to be comfortable.
You deserve to enjoy parenting.
And you don't need an 'official' diagnosis to achieve either of these things.

Áine x

Head to the links below for similar suggested blog titles:

• What Doctors Won't Tell You About Baby Reflux and Colic
• Why Isn't My Baby's Reflux Medication Working?
• Is My Baby Crying With Reflux or Colic Pain?