Burping and spit-up: how to wind your baby and when to worry
How and when to burp your baby, 3 burping positions, spit-up vs vomiting, reflux tips, safe sleep with reflux and the red flags that need a doctor.
Educational content only, not medical advice. Always talk to your doctor or health visitor about your child.
In this article
Burp your baby during and after feeds: the AAP suggests every 2 to 3 oz (60 to 90 ml) for bottle-fed babies, and when switching breasts for breastfed babies. Bringing up small amounts of milk (spit-up, or posseting) is very common and usually harmless, and most babies grow out of it as they get older. Forceful or projectile vomiting, green or yellow vomit, blood, poor weight gain or refusing feeds are different and need medical advice.
This guide follows the AAP and the NHS. It is educational, not medical advice. If you are worried about your own baby, talk to your doctor, health visitor or paediatrician.
Why do babies need burping?
Babies swallow air while they feed, especially when they gulp, cry before a feed, or feed from a bottle with a fast flow. That air can make them feel full and uncomfortable, and it can bring milk back up with it. Burping (also called winding) gives the trapped air a way out.
Not every baby needs burping every time. The AAP notes that some breastfed babies swallow very little air. If your baby has not burped after a few minutes of trying and seems content, it is fine to carry on feeding or stop.
When should I burp my baby?
- Bottle feeding: pause to burp after every 2 to 3 oz (60 to 90 ml), and again at the end.
- Breastfeeding: burp when you switch from one breast to the other, and at the end of the feed if your baby seems uncomfortable.
- Any time your baby fusses mid-feed. The AAP suggests stopping when your baby fusses, because fussing means more swallowed air. Burp, settle, then carry on.
How do I burp my baby? 3 positions to try
Whichever position you use, support your baby's head and neck, keep a cloth or bib under their chin, and pat or rub their back gently. You do not need to pat hard.
- Over your shoulder. Hold your baby upright with their chin resting on your shoulder. Support them with one hand and gently pat or rub their back with the other. Many parents find this easiest in the early weeks.
- Sitting on your lap. Sit your baby on your lap facing sideways. Support their chest and head with one hand, cupping their chin carefully (not their throat), and pat their back with the other.
- Face down across your lap. Lay your baby tummy down across your knees with their head a little higher than their chest, turned to one side. Hold them securely and gently pat or circle your hand on their back.
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Is it spit-up or vomiting?
| Sign | Spit-up (posseting) | Vomiting |
|---|---|---|
| How it comes out | Flows out easily, often with a burp | Forceful, using the tummy muscles |
| Amount | Usually small, though it can look like a lot | Often a larger amount |
| How your baby seems | Usually happy and comfortable | Often upset, crying or unwell |
| Usual cause | Normal reflux in a young baby | Can be illness or a feeding problem |
A little milk on a muslin looks like far more than it is. The AAP says spit-up "almost never" involves choking or danger, even during sleep.
What is reflux and when does it stop?
Reflux is when milk comes back up from the stomach into the food pipe or mouth. In babies it happens because the muscle at the top of the stomach is still developing and their stomachs are small. The NHS calls reflux very common and says it usually starts before 8 weeks old.
On when it gets better, the sources differ slightly. The AAP says reflux usually improves by about 6 months, when babies start sitting up, and that spit-up becomes less frequent as muscles mature. The NHS says it usually gets better by the time a baby is 1. Both agree that most babies simply grow out of it.
Signs of reflux can include bringing up milk during or after feeds, coughing or hiccupping during feeds, gulping, being unsettled during feeds, and crying. Some babies have "silent reflux," where they show the discomfort but do not bring milk up. If crying is the main problem, our guide to why your baby is crying may help.
How can I reduce spit-up?
These tips come from the AAP and the NHS:
- Keep your baby upright during feeds and for 10 to 15 minutes afterwards, or longer if you can.
- Burp during the feed, not just at the end.
- Offer smaller feeds more often. Overfeeding is one of the most common causes of spit-up. Small tummies fill quickly.
- Keep feeds calm. Feed before your baby is frantically hungry, and in a quiet place.
- Go easy after feeds. The AAP suggests limiting active play for 20 to 30 minutes, so no bouncing, jiggling or tummy time straight after a big feed.
- Check the latch or bottle. A midwife, health visitor or feeding specialist can check breastfeeding attachment. For bottles, make sure the teat flow suits your baby's age.
- Avoid tight nappies (diapers) or waistbands that press on the tummy.
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If your baby has formula and spits up a lot, or you are breastfeeding and wonder about a cow's milk allergy, talk to your doctor or health visitor before changing formula or your own diet. Do not add cereal or thickeners to bottles unless a doctor advises it.
What should I not do for reflux?
- Do not raise the head of the cot, crib or Moses basket. Both the NHS and the AAP advise against it. The AAP says it does not reduce reflux and your baby could slide into an unsafe position.
- Do not use wedges, sleep positioners or nests. The AAP says they are not proven safe.
- Do not use inclined sleepers or let your baby sleep in a car seat, swing or bouncer. A semi-upright position can actually make reflux worse.
- Do not put your baby to sleep on their side or front. Back to sleep still applies to babies with reflux. The AAP calls the idea that back-sleeping babies choke on spit-up a myth.
Always put your baby to sleep flat on their back, on a firm, flat mattress with nothing else in the cot. Our safe sleep basics guide covers the details.
Red flags: when to get medical help
Call your emergency number (999 in the UK, 911 in the US) or go to A&E (the ER) straight away if your baby:
- Vomits green or yellow-green fluid (bile)
- Vomits blood, or something that looks like coffee grounds
- Is floppy, very sleepy or hard to wake
- Has blue, grey or very pale skin or lips, or is struggling to breathe
Get an urgent appointment with your doctor, or call NHS 111 in the UK, if your baby:
- Vomits forcefully or projectile vomits, especially after every feed (this can be a sign of pyloric stenosis)
- Has blood in their poo
- Has a swollen or tender tummy
- Has a high temperature, or feels hot, cold or shivery
- Keeps being sick and cannot keep fluids down
- Refuses feeds
- Cries inconsolably
- Shows signs of dehydration, such as fewer wet nappies, a sunken soft spot or no tears (see our poo and wet nappies guide)
See your doctor (non-urgently) if your baby is not gaining weight or is losing weight, reflux is not improving with the tips above, reflux starts for the first time after 6 months, or it is still going on after their first birthday. You can check how your baby is tracking with our baby growth calculator and read about normal patterns in our guide to baby weight gain in the first year.
How can I track feeds and spit-up?
If you are seeing your doctor about reflux, a few days of notes on feed times, amounts and how your baby seemed afterwards can be really useful.
Baby Growth Tracker Pro logs feeds, sleep and nappies in one tap, and keeps track of growth and milestones, all offline. For more newborn care guides, visit our baby care hub.
Frequently asked questions
What if my baby will not burp?
Try a different position for a minute or two. If nothing comes up and your baby seems comfortable, that is fine.
Should I burp my baby before sleep?
If your baby has just fed, a gentle burp before laying them down can help them settle. Always put them down flat on their back afterwards, even if they spit up often.
Is it normal for my baby to spit up after every feed?
For many babies, yes. If your baby is happy, feeding well and gaining weight, frequent spit-up is usually just reflux and tends to ease with age. Talk to your doctor if it is forceful, green, contains blood, or your baby is not gaining weight.
Can I raise the cot mattress for reflux?
No. The NHS and the AAP both advise against raising the head of the cot or using wedges. It does not help reflux and can be dangerous. Keep the mattress flat.
How long does baby reflux last?
The AAP says reflux usually improves by around 6 months, when babies start sitting up. The NHS says it usually gets better by the time a baby is 1. See your doctor if it continues after their first birthday.
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