Burping, Hiccups & Spitting Up

Burping

Young babies naturally fuss and get cranky when they swallow air during feedings. Although this occurs in both breastfed and bottle-fed infants, it's seen more often with the bottle. When it happens, you're better off stopping the feeding than letting your infant fuss and nurse at the same time. This continued fussing will cause her to swallow even more air, which will only increase her discomfort and may make her spit up.

A much better strategy is to burp her frequently, even if she shows no discomfort. The pause and the change of position alone will slow her gulping and reduce the amount of air she takes in. If she's bottle-feeding, burp her after every 2 to 3 ounces. If she's nursing, burp her when she switches breasts.

How to Burp a Baby

Here are a few tried-and-true techniques. After a little experimentation you'll find which ones work best for your child.

  1. Hold the baby upright with her head on your shoulder, supporting her head and back while you gently pat her back with your other hand. If she still hasn't burped after several minutes, continue feeding her and don't worry; no baby burps every time. When she's finished, burp her again and keep her in an upright position for 10 to 15 minutes so she doesn't spit up.
  2. Sit the baby on your lap, supporting her chest and head with one hand while patting her back with your other hand.
  3. Lay the baby on your lap with her back up. Support her head so it is higher than her chest, and gently pat or rotate your hand on her back.

Hiccups

Most babies hiccup from time to time. This usually will bother you more than your infant, but if hiccups occur during a feeding, they may distress her. So change her position and try to get her to burp or relax. Wait until the hiccups are gone to resume feeding. If they don't disappear on their own in five to ten minutes, a few sucks of some water should stop them. If your baby gets hiccups often, try to feed her when she's calm and before she's extremely hungry. This will reduce the likelihood of hiccups during the feeding.

Spitting Up

Spitting up is another common occurrence during infancy. Sometimes spitting up means the baby has eaten more than her stomach can hold; sometimes she spits up while burping or drooling. Although it may be a bit messy, it's no cause for concern. It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while she's sleeping.

Some babies spit up more than others, but most are out of this phase by the time they are sitting. A few "heavy spitters" will continue until they start to walk or are weaned to a cup. Some may continue throughout their first year.

You should be able to tell the difference easily between normal spitting up and true vomiting. Unlike spitting up, which most babies don't even seem to notice, vomiting is forceful and usually causes great distress and discomfort for your child. It generally occurs soon after a meal and produces a much greater volume than spitting up. If your baby vomits on a regular basis (one or more times a day), consult your pediatrician.

Preventing Spitting Up

While it is practically impossible to prevent all spitting up, the following steps will help you decrease the frequency of these episodes and the amount spit up:

  • Make each feeding calm, quiet and leisurely.
  • Avoid interruptions, sudden noises, bright lights and other distractions during feedings.
  • Burp your bottle-fed baby at least every three to five minutes during feedings.
  • Avoid feeding while your infant is lying down.
  • Place the baby in an upright position in an infant seat or stroller immediately after feeding.
  • Do not jostle or play vigorously with the baby immediately after feeding.
  • Try to feed her before she gets frantically hungry.
  • If bottle-feeding, make sure the hole in the nipple is neither too big (which lets the formula flow too fast) nor too small (which frustrates your baby and causes her to gulp air). If the hole is the proper size, a few drops should come out when you invert the bottle and then stop.
  • Elevate the head of the entire crib with blocks (don't use a pillow) and put her to sleep on her back. This keeps her head higher than her stomach and prevents her from choking in case she spits up while sleeping.

Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999

© Copyright 2000 American Academy of Pediatrics