Burping baby after feeding lying down

How to burp a baby—and if you always have to do it

Our best advice for knowing how—and when—to burp a baby. Plus, why in some culture, burping a baby is unheard of!

It’s a traditional part of feeding a new baby: Baby lets go of the nipple, mom or dad sits the baby up and pats his back or massages his tummy until he burps. If you’re still figuring out how to burp a baby, you might ask yourself: Is this traditional way actually necessary?

“The theory is that babies swallow air during feedings and the air in their tummies makes them uncomfortable and gassy—hence the ritual of burping,” explains lactation consultant and nurse Jan Barger.

She points out, though, that in cultures where babies are carried upright in wraps or slings or an adult’s arms most of the time, burping a baby is unheard of. Barger adds that it can be upsetting to the baby who has just drifted off to sleep at the breast to be abruptly sat up and patted for several minutes until he finally lets out a burp. “It also makes the whole feeding process take much longer than necessary,” she says. Instead, Barger suggests parents keep the baby in a vertical position against a shoulder or in a carrier and if there is a burp to come up, it will just happen naturally.

On the other hand, there are situations where burping might not be such a bad idea.

When to burp a baby

• If the baby had been crying for a while before you started to feed him, he might have swallowed air while crying and need help in bringing it up. You may find it helpful to burp the baby before feeding him.

• If you are feeding your baby with a bottle, she’s less likely to be able to make a good seal around the nipple, so she’ll swallow more air while feeding. In addition, “because most bottles have a very fast flow, the baby usually ends up gulping the liquid down and gulps air along with it,” says Barger.

• That very fast flow is a problem for some breastfeeding mothers as well. According to Barger: “If the mother has an overactive letdown or an overabundant milk supply and her baby gulps milk very quickly, that baby may be swallowing a lot of air and need help with burping.” (A lactation consultant or La Leche League leader can help with tips on how to reduce the too-fast flow of milk.)

If one of these situations applies to you, or your baby seems uncomfortable after feeding and you suspect a burp might help, what’s the best approach? Each baby is different, but the key is to have the baby vertical and put a little pressure on his tummy.

Best positions for burping a baby

• Try putting the baby high up on your shoulder so that your shoulder presses just below his tiny ribcage, then gently pat his back. (Oh yeah, arrange a receiving blanket or burp pad on your shoulder first. Trust me on this!)

• Are you feeding lying down? No need to get up! While lying on your side, drape the baby over your hip, facing toward your back (which puts a little pressure on his tummy) and pat his back gently.

• With a small baby, the “folding” technique sometimes works. Hold baby in a sitting position, then gently bend her forward, chest toward knees (“folding” the baby in half) and then straighten her up again. Repeat a couple more times. (Laying the baby on her back and bending her knees to her chest can sometimes help with gas at “the other end,” but it’s less effective in bringing up burps; since air tends to rise, a vertical position is more helpful and leads to less spitting up.)

If you don’t hear a satisfying belch after a minute or two, chances are there’s no burp to come up. However, if your baby starts to grimace or wiggle around as though he’s uncomfortable when you lay him down, it’s worth giving it another try. It’s just about the only time in his life when a loud buuurp will get the response: “Oh, good boy! That was a good one!”

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FILED UNDER: Baby 0-3 months Baby safety Bottle-feeding Breast milk New baby Steps and Stages

Burping Your Baby (for Parents)

Reviewed by: Madhu Desiraju, MD

Primary Care Pediatrics at Nemours Children's Health

en español Hacer eructar a su bebé

An important part of feeding a baby is burping. Burping helps to get rid of some of the air that babies tend to swallow during feeding. Not being burped often and swallowing too much air can make a baby spit up, or seem cranky or gassy.

How to Burp Your Baby

When burping your baby, repeated gentle patting on your baby's back should do the trick. Cup your hand while patting — this is gentler on the baby than a flat palm.

To prevent messy cleanups when your baby spits up or has a "wet burp," you might want to place a towel or bib under your baby's chin or on your shoulder.

Try different positions for burping that are comfortable for you and your baby. Many parents use one of these three methods:

Sit upright and hold your baby against your chest. Your baby's chin should rest on your shoulder as you support the baby with one hand. With the other hand, gently pat your baby's back. Sitting in a rocking chair and gently rocking with your baby while you do this may also help.
Hold your baby sitting up, in your lap or across your knee. Support your baby's chest and head with one hand by cradling your baby's chin in the palm of your hand. Rest the heel of your hand on your baby's chest, but be careful to grip your baby's chin, not the throat. Use the other hand to pat your baby's back.
Lay your baby on your lap on his or her belly. Support your baby's head and make sure it's higher than their chest. Gently pat your baby's back.

If your baby seems fussy while feeding, stop the session, burp your baby, and then begin feeding again. Try burping your baby every 2 to 3 ounces (60 to 90 milliliters) if you bottle-feed and each time you switch breasts if you breastfeed.

Try burping your baby every ounce during bottle-feeding or every 5 minutes during breastfeeding if your baby:

tends to be gassy
spits a lot
has gastroesophageal reflux (GER)
seems fussy during feeding

If your baby doesn't burp after a few minutes, change the baby's position and try burping for another few minutes before feeding again. Always burp your baby when feeding time is over.

To help prevent the milk from coming back up, keep your baby upright after feeding for 10 to 15 minutes, or longer if your baby spits up or has GERD. But don't worry if your baby spits sometimes. It's probably more unpleasant for you than it is for your baby.

Sometimes your baby may awaken because of gas. Picking your little one up to burp might put them back to sleep. As your baby gets older, don't worry if your child doesn't burp during or after every feeding. Usually, it means that your baby has learned to eat without swallowing too much air.

Babies with colic (3 or more hours a day of continued crying) might have gas from swallowing too much air during crying spells, which can make the baby even more uncomfortable. Check with your pediatrician before giving your baby anti-gas drops.

Reviewed by: Madhu Desiraju, MD

Date reviewed: June 2022

why baby spit up after feeding

If a child spits up after feeding, this is in most cases due to the anatomical immaturity of the upper digestive system. More often than others, premature babies, babies with congenital pathologies suffer from regurgitation. Sometimes the cause is the wrong breastfeeding technique.

Regurgitation in infants is perhaps the most common occurrence in modern pediatrics. More than half of children spit up at least once a day, which is almost always a physiological reaction. nine0003

As the baby grows older, spitting up less and less and by 6 months it practically stops doing so. However, sometimes the problem remains, and burping continues for up to a year. In such a situation, you need to make sure that the gastrointestinal tract is functioning normally and consult a doctor.

Why does the baby spit up after every feed

There is a very simple explanation for this. The esophagus of newborns is a funnel with a wide part at the top, and the sphincter at the transition to the stomach actually gapes and hardly retains food. nine0003

Normally, after food enters the stomach, the sphincter contracts and prevents it from “returning” into the esophagus. But in this case, when the stomach is full, part of the contents immediately comes out if the baby takes an inclined or horizontal position.

Babies have two more features: increased pressure over the lower esophageal sphincter, as well as a straight and sometimes obtuse angle of His, formed by the side walls of the esophagus and stomach. In adults, this angle is sharp, which also prevents the return of food eaten into the esophagus. nine0003

After feeding, do not put the baby on his stomach, it is better to hold him upright in your arms, trying not to put pressure on his chest. But if he still burps, you should not worry, this is a normal process. If in doubt, please contact our doctors. At a remote consultation, they will explain the causes of regurgitation, talk about pathologies. If necessary, they will tell you which specialists to go through.

A few more reasons why a child often spit up

Physiological belching after feeding is due to two factors: swallowing air (aerophagia) and increased intra-abdominal pressure. The first is usually associated with fast and greedy suckling, improper attachment of the baby to the breast, or the wrong position of the bottle when it comes to artificial feeding. An air bubble forms in the stomach, pushing out a small amount of milk or mixture.

The same results are obtained by a quick change in the position of the baby's body after feeding, which will easily burp if it is immediately started to swaddle, shake, bathe or massage. After all, his stomach resembles an open bottle: tilted / turned over - the contents spilled out. nine0003

As for the increase in intra-abdominal pressure, it increases with a too tight-fitting diaper or tight swaddling, as well as against the background of increased gas formation, intestinal colic or stool retention.

Regurgitation in newborns after feeding may be due to the lack of a feeding regimen and overeating.

Baby burps an hour after feeding: what does it mean

The most common cause is constipation, which increases intra-abdominal pressure. Food moves slowly through the gastrointestinal tract, so the child can burp an hour or two after feeding. nine0003

Attention! Delayed regurgitation combined with delayed defecation may be a sign of a lazy stomach. But such a diagnosis should be made by a doctor.

5 causes of regurgitation in newborns after formula feeding

The selection of artificial nutrition is a purely individual process with an unpredictable result. There is no 100% guarantee that the mixture will suit the child, even if the brand is very popular. nine0003

Poor digestion of the mixture may well cause not only frequent spitting up, but also other digestive problems, including colic, constipation and allergic reactions. In addition, store-bought baby food has a denser texture than breast milk and lasts longer in the stomach. Therefore, the likelihood of its reverse advance to the esophagus after feeding is higher.

Your baby may be spitting up after every feed because: nine0003

the proportions of dilution of the mixture are violated;
the feeding regime is not observed;
the transition from breastfeeding to artificial feeding was too abrupt;
the wrong bottle is selected;
allergy.

Misproportioning when diluting the mixture

Each manufacturer indicates on the packaging of the mixture how much water is required to dilute it, and what volume is suitable for the baby by weight and age. Sometimes mothers mistakenly or intentionally dilute food in a way that is not recommended, and the child eats more than normal. As a result, the surplus, of course, comes out. nine0003

Case study:

After 3 months, a breastfed child suddenly began to behave restlessly, sleep poorly, spit up after eating, weight gain became slightly below normal. From a conversation with the mother, the doctor learned that the baby was fed too often, the feeding regimen was not observed. After increasing the intervals between breastfeeding, the regurgitation stopped.

Refusal of night feedings is also undesirable: the daily volume of food is distributed during the daytime, which leads to stomach overload and regurgitation. nine0003

Feeding schedule not followed

Unlike natural, artificial feeding involves eating by the hour.

Baby food takes longer to digest, so the recommended interval between feedings is at least 3 hours. If you feed the child more often, he will “give out” the excess back, since the previous portion has not yet been absorbed.

Abrupt transition from breastfeeding to artificial feeding

nine0002 When changing the diet, the child's body must first get used to, adapt to the new food. This applies not only to the transition from breastfeeding to artificial feeding, but also from one type of mixture to another.

Wrong bottle selected

This refers to the too wide neck of the container, because of which the child swallows a lot of air along with food. Its discharge will provoke regurgitation after feedings.

Allergy

nine0002 An allergic reaction to cow's milk protein causes inflammation of the intestinal wall, which in turn leads to malabsorption. Carbohydrate metabolism worsens, since secondary lactase deficiency occurs against the background of an inflammatory reaction - a decrease in the synthesis of the lactase enzyme.

As a result, sugar is broken down incorrectly, increased gas formation occurs, and the baby spits up a fountain. In addition, the baby may feel discomfort at the beginning of feeding and react with an increase in nervous excitability during the period of increased intestinal motility. This also often leads to belching. nine0003

What does curd spitting up mean

Belching with curdled milk after feeding only indicates that the food was in the stomach for some time and managed to curdle - it was fermented. The reason may be in a change in body position or indicate pyloric stenosis with profuse vomiting with a fountain.

Attention! When spouting against the background of pyloric stenosis, the child spits up profusely, the jet scatters to a distance of half a meter. nine0003

What to do

First you need to make sure that you really need to do something. Pediatricians are advised to determine the intensity and frequency of regurgitation on a five-point scale.

nine0120

Points	Regurgitation frequency	Volume nine0111
one	No more than 5 per day	Not more than 3 ml
2	> 5 times a day	> 3 ml
3	> 5 times a day	> 0. 5 volume of food eaten
4	After every feeding	Small amount over 30 minutes or more nine0003
five	At least half of the meals are accompanied by regurgitation	> 0.5 volume of food eaten

Now you can determine if there really is a problem. The criteria are:

the baby is not yet a year old; nine0046
he spits up 2 times a day for 3 weeks or longer;
before burping there are no precursors, specific signs;
during regurgitation, the tension of the anterior abdominal wall is not felt;
there are no difficulties with swallowing, sucking, the child does not take any specific forced position;
the baby does not begin to sweat a lot, turn pale after burping, and feels normal; nine0046
he is active, has a good appetite, and is gaining weight appropriately for his age.

The above points indicate that everything is in order.

If the intensity and frequency of spitting up is 3 points or more, this is a reason to consult a doctor. Our doctors are ready to advise on all issues at any time of the day. At a remote consultation, possible causes will be identified, and a plan of further actions will be drawn up. nine0003

How parents determine the amount of rejected food

Normal regurgitation after feeding occurs in small volumes, within 1-2 tablespoons. You can determine how much food came out when you burp.

When the child burps into the diaper, you need to pour 1 tbsp nearby. l. water and compare the size of the spots. If they are almost the same, there is no reason to worry.

Alarm symptoms

Medical assistance is necessary if the child spits up a lot after feeding, while crying and acting up. A bad symptom is the requirement of supplementary feeding, that is, the baby remains hungry after he has eaten his portion.

Serious illnesses can present with symptoms such as:

sudden weight loss, weight gain does not meet the standards;
lack of stool;
urination less than 8-10 times a day;
continued spitting up after the child is one year old.

How to deal with regurgitation: a step-by-step guide

If the baby is spitting up after feeding breast milk or formula, you can start with a nutritional correction. When breastfeeding, it is important to ensure that the baby completely captures the nipple along with the areola. His lower lip is usually slightly twisted. nine0003

Step 1

It is better to feed the baby while sitting, holding the baby at an angle of 45-60 ° to the chest. In this position, the air freely leaves the stomach, due to which the likelihood of reflux of food into the esophagus is reduced. After eating, it is preferable to put it on its side in a crib: this way, when returning from the stomach, the masses will not enter the respiratory tract. If the child burped while lying on his back, you should lift him up and turn him face down.

Step 2

After the baby has eaten, it must be held upright (pose of a soldier) for at least 20 minutes. nine0003

Step 3

You can partially remove the air from the stomach before feeding, putting the baby on the stomach for 10-15 minutes. With a tendency to intestinal colic, a light massage of the abdomen, which is done in between meals, will help.

Step 4

Even if the child is constantly spitting up, this is not a reason to transfer him to artificial mixtures. But a clear feeding regimen is desirable after a more or less strict period of time. In addition, mom should follow a hypoallergenic diet and exclude foods that can provoke flatulence - cabbage, legumes, black bread. nine0003

Step 5

For artificial babies, it is preferable to use a special anti-colic bottle and a nipple with a special design. The bottle has a valve that prevents you from swallowing air while eating. It is also necessary to make sure that the milk does not flow like a river, but slowly drips, that is, the hole in the nipple must have the appropriate diameter.

Step 6

When buying a mixture for a spitting up baby, it is better to consult a pediatrician. He may recommend a hypoallergenic formula or a formula that does not contain bovine protein. For some children, the so-called anti-reflux mixture is suitable. nine0003

Step 7

Normally, complementary foods are introduced from the 4th month of a child's life, but in the presence of regurgitation, it is allowed to include food thickeners in the diet after the 1st month. It can be mixtures with rice flour, rice porridge without milk. But they are used in an amount of a maximum of 1 tsp. in one feeding.

Pitch 8

Do not swaddle too tightly, massage, and generally somehow disturb the child after eating. You can only lightly pat him on the back, putting him on his knees, to prevent spitting up. nine0003

Step 9

Is the child overeating? To check this, you just need to weigh it before feeding and after. And it does not matter what he eats - mother's or artificial milk.

FAQ

What symptoms should you call an ambulance for?

If, after spitting up, the child does not breathe or has lost consciousness; lips and face take on a bluish tint; reflux - gastric contents - has a green or brownish color, which may indicate intestinal obstruction, gastric bleeding. nine0003

Why does a baby spit up breast milk, but formula does not?

If everything is in order with the calculation of “doses”, and there is no overfeeding with breast milk, most likely it is lactose intolerance. To clarify the diagnosis, it is necessary to take tests.

Should I supplement my baby if he burps?

No, by no means.

What complications can regurgitation cause? nine0003

Lack of weight gain and even weight loss are the most harmless consequences. With a long-term existence of the problem, 15% of children have a developmental delay, however, only in the physical. Insufficient digestion of food leads to anemia, vitamin deficiency and an increased risk of aspiration pneumonia when inhaled gastric masses.

Expert opinion

If the baby spit up after feeding, this is completely normal in the absence of alarming symptoms. In case of profuse regurgitation, insufficient weight gain, restless behavior, the baby should be shown to the pediatrician. nine0003

Why does the baby spit up after feeding?

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Search Keywords

Regurgitation is a common condition in newborns and infants and is most often a normal variant. However, it is not uncommon for parents to worry if their baby is spitting up frequently, believing that this is due to nutritional or health issues with the baby in general. Sometimes these fears are not unfounded, and regurgitation really has a pathological origin. What is its cause and when should you really consult a doctor about this? nine0003

Regurgitation - Return of a small amount of food (uncurdled or partially curdled milk) from the stomach up the digestive tract: into the esophagus and further into the oral cavity. According to statistics, at least 1 time during the day can spit up at least 50% of babies from 0 to 3 months, more than 60% of children 3-4 months, and 5% of children spit up until the year ¹.

Regurgitation in newborns is considered a physiological process. It is caused by a number of factors, including:

Structural features of the upper digestive tract in babies
In newborns and infants up to a year of life, the stomach has a spherical shape. It holds a small amount of food, besides, the release from it into the duodenum is slower in comparison with children after the year ².
Weakness of the lower esophageal sphincter that separates the esophagus from the stomach
Normally, the lower esophageal sphincter should tightly "close" the esophagus, allowing food to pass into the stomach and not allowing it to enter back into the upper digestive tract. However, in young children (up to a year), the muscles of the esophageal sphincter are poorly developed, and it does not do its job very well ² .
Slow movement of food through the gastrointestinal tract
The neuromuscular apparatus of newborns is immature. It does not ensure the proper movement of food through the esophagus, causing regurgitation.

One of the important risk factors contributing to regurgitation in newborns is aerophagia. This is the swallowing of large amounts of air during feedings. This happens when the baby is not properly attached to the breast, the mother has a lack of breast milk, or the bottle is in the wrong position in the child who receives the mixture. The size of the opening in the nipple also matters - if it is too large, the newborn swallows a lot of air ³ .

With aerophagia, the baby becomes capricious, restless immediately after feeding. Noticeable bloating. If the baby spits up immediately after a feed, the milk (or formula) remains practically fresh, uncurdled ³ .

Promotes post-feeding regurgitation and predominantly horizontal position during the day, combined with relatively high intra-abdominal pressure ⁴ . Therefore, the correct position of the baby after feeding is so important. To avoid regurgitation of an excessive amount of stomach contents, after feeding, it is necessary to hold the baby in an upright “column” position for some time (10-20 minutes), lightly patting on the back and allowing excess air to “exit”. nine0003

Regurgitation in many newborns can be triggered by other situations in which abdominal pressure increases and stomach contents are thrown into the esophagus, in particular ³ :

tight swaddling;
stool disorders, in particular constipation;
long, forced cry and some others.

Want to avoid common feeding problems? nine0057

Start with a baby bottle with an anti-colic system that helps you avoid common feeding problems such as colic, gas and spitting up*

How can you tell the difference between normal spitting up and vomiting?

Sometimes regurgitation is considered a manifestation of disorders in the digestive tract of children. Due to the constant reflux of acidic stomach contents into the upper sections, inflammation and other complications may develop, including growth retardation, a decrease in hemoglobin levels, and others. Therefore, it is important for parents to understand where the line is between physiological and pathological regurgitation ¹ .

If the mother is worried that her baby is spitting up, keep track of when this happens and count the total number of spit ups per day. Normally, regurgitation usually occurs after eating (the child burps after each feeding), lasts no more than 20 seconds and repeats no more than 20-30 times a day. With pathology, the problem manifests itself at any time of the day, regardless of when the baby was fed. Their number can reach 50 per day, and sometimes more ¹ .

The amount of discharge during regurgitation also matters. With normal, physiological regurgitation, it is approximately 5 - 30 ml. If this volume fluctuates between 50 and 100 ml, it is already defined as profuse vomiting. When the range of the jet of vomit is up to 50 cm, doctors talk about "vomiting a fountain." A variant of atonic vomiting is possible, when the contents of the stomach flow "sluggishly". It occurs with atony of the stomach (decrease in muscle tone of the stomach wall) and disruption of the esophagus ¹ .

Vomiting in babies is a warning sign. Doctors are especially alarmed by repeated vomiting, a fountain, with an admixture of bile, in combination with constipation. Vomiting can lead to the development of dehydration, acid-base imbalance and other consequences, so if it occurs, you should urgently contact your pediatrician to find out the cause and start treatment. A doctor's consultation is necessary if the child is spitting up a lot (more than 15-30 ml at a time), with a frequency of more than 50 episodes per day ^1.3 .

Physiological regurgitation: symptoms

Regurgitation in newborns, which is considered a normal variant and is not of concern to pediatricians ³ :

usually lasts for a certain period of time;
is characterized by slow, "passive" leakage; if the baby spits up a fountain, it is better to consult a doctor;
has a sour smell of curdled milk;
occurs without the participation of muscles - the baby does not strain during regurgitation;
does not affect the general well-being of the baby.

How can I help a newborn who vomits frequently?

If the baby is healthy, no medication is prescribed for spitting up. To help the child allow simple measures based on lifestyle changes and feeding.

Frequent feeding of the baby
It is known that the baby is more prone to spit up if his stomach is full. To improve the situation, it is recommended to feed the baby more often, avoiding oversaturation, best of all - on demand ⁵ .

Correct feeding technique
Every feeding, the mother must ensure that the baby does not swallow too much air during suckling. When sucking, there should be no loud, smacking, clicking sounds. You also need to control that the baby captures the nipple along with the areola.

Choosing the right bottle and nipple
If the newborn is bottle-fed and receiving formula, it is important to choose the right bottle and nipple. The hole in it should be such that the milk flows out in drops, and not in a stream. The nipple must not be filled with air
New Anti-colic bottle with AirFree valve

The AirFree valve prevents air from entering the baby's stomach.
- Baby standing upright after eating
To allow air that has entered the digestive tract during meals to escape, it is important to keep the newborn upright for 10-20 minutes after feeding ⁴ .
- Ensure the correct position of the baby during sleep
To reduce the negative impact of the acidic contents of the stomach on the esophagus, it is necessary to put the baby to sleep in the supine position. The side or prone position, which many pediatricians used to recommend, is no longer recommended. It turned out that it is associated with an increased risk of sudden infant death syndrome ⁵ .

If parents notice alarming symptoms, such as spitting up too often or large volume, etc., it is important to consult a pediatrician without delay. This will allow you to identify the real problem in time and help the baby grow up healthy and happy. nine0003

References
¹ Zakharova I. N., Andryukhina E. N. Regurgitation and vomiting syndrome in young children // Pediatric pharmacology, 2010. Vol. 7. No. 4.

Nagornaya 29031 V., Limarenko M. P., Logvinenko N. G. Experience with the use of domperidone in suspension in young children with regurgitation syndrome // Child Health, 2013. No. 5 (48).

³ Zakharova IN Regurgitation and vomiting in children: what to do? //Pediatrics. Supplement to Consilium Medicum, 2009. No. 3. S. 58-67.

⁴ Zakharova I. N., Sugyan N. G., Pykov M. I. Regurgitation syndrome in young children: diagnosis and correction // Effective pharmacotherapy, 2014. No. 3. P. 18-28.

⁵ Vandenplas Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) //Journal of pediatric gastroenterology and nutrition. 2009; 49(4): 498-547.

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