Breast-fed infants should be offered the opportunity to burp regularly. At times, infants will suck enthusiastically or cry at the breast, causing them to swallow air. Air bubbles then mix with the milk as it enters the stomach and could cause pain and/or spitting up during or after the feed. It is very important to allow an infant to bring up these air bubbles.
Effective burping requires two actions: proper positioning and gentle pressure. Proper positioning of the infant will allow any air bubbles to rise to the top of the stomach and gentle pressure will help to release them.
Before you begin, be sure to place a burp cloth on your shoulder to protect your clothing from spit up. There are a few positions to try. You may find one that seems to work best for your baby. Be sure to visit our How to Burp Your Baby slide show for more information.
- Sit the infant on your lap and lean him forward, against the heel of your hand and firmly pat or rub the infant's back. Because babies have weak neck muscles, support the chin between your thumb and index finger while the infant is sitting.
- Drape the baby over your shoulder and firmly pat or rub his back from the base of the spine to the shoulder.
- Lay the baby on his stomach across your lap, turning his head to the side so that he can breathe freely, and then gently pat or rub the back.
- If you are breastfeeding in bed using the side-lying position, try draping the baby over your hip.
If the baby does not burp, rest for a few seconds and then try again. If after one or two minutes, there are no burps and the baby seems comfortable, then go about your business. However, if the baby is fussy or restless, then keep burping until infant is comfortable. After the baby is about 4 or 5 months of age, you will not need to burp your baby. Older babies swallow less air when feeding and burp on their own if necessary.
Spitting up can be messy and inconvenient, but generally it is not a cause for serious concern. The connection between the baby's mouth and stomach is very short, and the stomach valve is not well developed at birth. Generally, it matures as the infant grows and spitting up decreases by 6 to 7 months, around the time that the infant can sit upright.
There can be a number of causes for spitting up, such as: an overactive letdown, overfeeding, and mucous in the infant's stomach (this is very common in the first few days after birth). If a mother smokes, the nicotine can cause spitting up. Some medications and foods taken by the mother can also make a baby more likely to spit up. If a mother waits too long between feeds, the hungry infant may feed eagerly and quickly, swallowing more air.
The following are some suggestions to help reduce the likelihood of the baby's spitting up:
- Gravity helps to keep the milk in the stomach longer. Try to keep the infant upright during and after a feeding (for 15 to 30 minutes).
- Burp your baby not only after the feeding, but also during the feeding. This can be done when switching sides.
- Handle the baby very gently for at least 30 minutes after the feeding.
- Do not put your baby on his belly to sleep unless you have been told to do so by a health care provider. Sleeping on the back reduces the risk of sudden infant death syndrome and will not cause choking in healthy babies.
Call your health care provider if the infant has any of the following symptoms:
- Vomiting that increases in frequency or becomes forceful (projectile), where it shoots out, missing the baby's clothes.
- Vomiting that does not look like curdled milk. Call the doctor immediately if the vomit is green or contains blood.
- Inconsolable crying associated with the vomiting.
- No wet diapers in 6 hours.
- Other signs of dehydration such as dry mouth and lips, excessive sleepiness, sunken eyes, sunken soft spot, and wrinkled skin.