Burping, spit-up and reflux: what is normal and what needs treatment

Burping properly

Three positions work: over the shoulder with the baby's tummy against your chest; sitting upright on your lap with your hand supporting the chin and jaw (not the throat); and lying face-down across your lap. Pat or rub the back gently — thumping harder does not speed it up.

Burp midway through a feed and at the end, and give it a few minutes rather than thirty seconds. If nothing comes after five minutes, the baby probably does not need to.

Breastfed babies usually swallow less air than bottle-fed ones and often need less burping. A bottle-fed baby who gulps, splutters or drains the bottle in five minutes almost certainly has too fast a teat, which is the commonest cause of wind and spit-up.

Keep the baby upright for fifteen to twenty minutes after a feed, and avoid bouncing, tummy-time or a nappy change with legs pushed up immediately afterwards.

Normal spit-up versus reflux that matters

Normal reflux: effortless posseting of small amounts, sometimes after every feed, in a baby who is comfortable, feeding well and gaining weight. It peaks around four months and usually resolves by around a year as the valve at the top of the stomach matures and the baby spends more time upright. It looks like a lot because milk spreads.

Reflux that needs attention (GERD): arching and screaming during or after feeds, refusing feeds or pulling off repeatedly, poor weight gain, frequent forceful vomiting, coughing or choking with feeds, wheezing, or a baby who is genuinely distressed rather than just messy.

Cow's-milk protein allergy mimics reflux closely and is often the real answer, especially with eczema, blood or mucus in the stool, or a strong family history of allergy. That is a doctor's diagnosis and it changes the treatment entirely.

What helps, and what to avoid

Smaller, more frequent feeds. Paced bottle feeding, with the baby semi-upright and in control of the pace. A slower teat. Careful burping. Upright time after feeds.

For breastfed babies, a check of the latch — a shallow latch means more swallowed air. For an oversupply or fast let-down, feeding in a more reclined position helps the baby manage the flow.

What not to do: do not raise the head of the cot with pillows or wedges, and do not put a baby to sleep on the front or side to reduce reflux. Back-sleeping on a flat firm surface remains the rule, and sleep-positioning products are a suffocation risk.

Do not add cereal or gripe water to bottles. Acid-reducing medicines are prescribed only for diagnosed reflux disease, and are over-prescribed to Indian babies who simply spit up — they carry their own risks and should not be a first response.

When to see a doctor

Emergency: green or yellow-green vomit, blood in the vomit, projectile vomiting in a baby under three months, a baby who chokes or turns blue during feeds, a swollen tender abdomen, or a baby who is limp or unresponsive. Call 108 for breathing difficulty.

Same-day: poor weight gain or weight loss, refusing feeds, fewer than six wet nappies a day, blood or mucus in the stool, persistent distress with feeding, or any fever in a baby under three months.

This article is general information, not medical advice, and is no substitute for personal medical advice. For any decision about your or your child's health, please consult your doctor.

Frequently asked questions

Q: My baby spits up after every feed but is happy and gaining. — That is a laundry problem, not a medical one. Keep a muslin handy; it resolves as the baby grows and starts sitting.

Q: What if the baby falls asleep without burping? — Hold them upright for ten to fifteen minutes and put them down on their back. Missing one burp is not a problem.

Q: Does gripe water help wind? — There is no good evidence, the contents vary, and it displaces milk in a small stomach. Skip it.

Q: Should I change formula because of spit-up? — Not on your own. Some babies do need a change for a diagnosed allergy, but repeatedly switching formula is a common and unhelpful response to normal reflux. Ask the paediatrician.