Burping vs Reflux: What's the Difference?

These two get mixed up all the time, by me too for many years, and the mix-up has a cost, because you respond to them differently and one of them can be a medical question.

Wind is air going the wrong way, and reflux is milk going the wrong way. Almost everything else follows from that.

Telling them apart

Timing tells you most of it. Wind is an event with a start and an end: she's uncomfortable, something comes up or passes through, and she's better. Reflux is more like a state. It comes during feeds as well as after them, and a burp doesn't fix it because there's no air to let out, however long you pat. I'm not sure I'd have seen the difference with my first. I do now.

The other reliable difference is what she does with her body, and this is the one I'd watch for. A baby with wind tends to pull her knees up. A baby with reflux tends to arch backwards and pull away from the feed, which is nearly the opposite movement. Once you've seen both, you won't mix them up again.

How common is this, really?

Bringing milk up is almost universal and very rarely a disease.

About half of babies regularly bring up milk in the early months. It peaks at about four months, and most have grown out of it by twelve, as the valve at the top of the stomach matures and they spend more of the day upright. The joint paediatric gastroenterology guidelines are clear that nearly all of it needs no treatment beyond reassurance, time and a great many muslins.

Only in a small number of babies does it become reflux disease, causing real harm and not just mess. That's the whole clinical question, and it's why doctors ask about weight and distress and never about volume, whatever the state of your laundry.

Silent reflux, and why it gets missed

Some babies bring milk part of the way up and swallow it again, so there's nothing to see and nothing to wash. The discomfort is invisible to anyone looking for spit-up, which is everyone.

What you see instead is a baby who's upset during and after feeds, who arches and pulls away, who swallows repeatedly or makes gulping sounds between feeds, and who may have a hoarse cry or a cough that won't go. She often gets called colicky because nobody has linked it to feeding. I called one of mine that for months.

It gets missed because everyone, including many professionals, is looking for the milk. If your baby has the distress without the mess, say exactly that at the appointment instead of calling her unsettled, because the words you use change what gets considered.

What helps

Almost everything you can do is positional and it costs nothing.

• Smaller feeds, more often, so there's less in the stomach at any moment.
• Upright or laid-back positioning during feeds, and upright for twenty to thirty minutes afterwards.
• Paced bottle feeding, or feeding lying back if your let-down is fast.
• Gentle, brief winding. Firm patting and jiggling both make it worse.
• Nothing pressing on the abdomen, no tight waistbands, no bending her at the hip, no shoulder in her stomach.
• No bouncing or vigorous play immediately after a feed.

One thing isn't up for debate, whatever the reflux is doing: sleep stays flat and on her back. Don't prop the cot, don't put anything under the mattress, don't use an inclined sleeper (they've been recalled after deaths), and don't put her on her front or side. No safe-sleep authority makes an exception for reflux, and nobody, my own mother included, could talk me round on this one.

Reflux stops being a laundry question and becomes a medical one at a fairly clear line.

• Weight gain that has flattened, or weight crossing downward through centiles.
• Refusing feeds, or real distress and arching during most of them.
• Forceful or projectile vomiting after most feeds, particularly under two months.
• Green or bile-stained vomit, or blood in vomit or stools, which is emergency care now.
• A persistent cough or wheeze, or repeated chest infections.
• Regurgitation beginning for the first time after six months, or continuing past twelve to eighteen.
• Any of it alongside eczema, blood or mucus in the nappy or diarrhoea, which raises cow's milk protein allergy.

Take that to a doctor before you try anything yourself. Several quite different conditions look the same from the outside, and reflux medicines aren't harmless and are given to babies far more often than the guidelines support.

I'll end where I began. I burped five babies thoroughly and called a lot of ordinary reflux wind, because wind was the word I'd been given. Knowing the right word sooner would have saved me some worry and my children a lot of patting.

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What people ask me

What I read before I wrote

• Rosen et al. (2018), JPGN 66:516-554: Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: NASPGHAN and ESPGHAN joint recommendations
• NHS: Reflux in babies
• American Academy of Pediatrics: Burping, hiccups and spitting up
• The Lullaby Trust: Safer sleep advice
• HealthHub: Ministry of Health Singapore

This guide is general information, written to help you understand a topic and ask better questions. It is not medical advice and does not replace your own doctor, midwife or paediatrician. Anything that worries you about your baby belongs with them.

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