Why Does My Baby Spit Up When Burping?

Because you've just moved a full stomach into a vertical position and pressed on her back, so milk that was resting comfortably now has somewhere to go, and the valve at the top of a young stomach isn't much of a valve yet.

There's a more interesting version of this answer, though, which is that the winding itself may be causing some of it, and I'll come to that.

How much is normal

A great deal more than most people expect. Around half of all babies bring milk up regularly in the first months, it peaks at about four months, and the large majority have stopped by their first birthday, by which time you'll have stopped noticing.

The distinction that counts is between a happy spitter and an unhappy one. A baby who brings up milk, seems entirely unbothered, feeds well and gains weight has a laundry problem. A baby who's distressed by it, arches and pulls away from feeds, refuses feeds or isn't gaining weight has something that wants looking at, and the two need to be kept apart in your head.

The volume looks far larger than it is. A tablespoon of milk on a muslin spreads to something that looks like the whole feed, and I'd pour a tablespoon of water onto a cloth once, simply to recalibrate what you're seeing, because I did it with my third and stopped worrying that afternoon.

How to reduce it

Most of this is done during the feed and not after it.

• Smaller feeds, more often, so there's less in the stomach at any moment.
• Keep her upright or semi-reclined during the feed, and hold her upright for twenty to thirty minutes afterward.
• Slow the feed down. Paced bottle feeding with the bottle horizontal, or feeding lying back if your let-down is fast.
• Wind gently and briefly. Firm patting and jiggling both increase spit-up a good deal, which is good to know before the next attempt.
• Don't press her abdomen. Check your shoulder isn't in her stomach in the shoulder hold, and keep her legs free and never bent up at the hip.
• No bouncing, no vigorous play and no nappy change immediately after a feed if you can avoid it.

Here's the part I didn't know when I had mine. The one randomised trial that has looked at burping found that babies who were burped after every feed brought up roughly twice as much as those who weren't, and that burping made no difference to colic, and while it's a single small study — not the last word — it does point clearly in one direction: if your baby brings up a great deal and is otherwise well, winding her less and more gently is a perfectly reasonable thing to try. I'm told some paediatricians disagree. I'd like to hear their reasons.

That runs against everything I was taught, and against what I told my own daughters for years, and I'm not going to repeat it.

Spit-up or reflux?

They're the same process, and the words describe different amounts of trouble.

Bringing milk up is reflux in the literal sense, and in most babies it's simply what a young digestive system does, and it becomes gastro-oesophageal reflux disease, the version that gets treated, when it's causing harm: distress, refusing feeds, poor weight gain, a persistent cough, or blood.

The question is never how much came up. It's whether she minds.

When to see a doctor

These are the ones that aren't laundry.

• Forceful or projectile vomiting after most feeds, particularly in a baby under two months, which needs assessment promptly.
• Green or bile-stained vomit, or blood in vomit or stools, which is emergency care now.
• Poor weight gain, or weight crossing downward through centiles.
• Refusing feeds, or real distress and arching during them.
• A persistent cough, wheeze or repeated chest infections.
• Vomiting alongside fever, unusual drowsiness or fewer wet nappies.
• Bringing up milk that begins for the first time after six months, which is worth a look.

The laundry problem nobody warns you about

Milk sets. If it dries into cloth it leaves a mark and a smell that ordinary washing won't shift, and in a warm humid climate it does so within hours, as anybody who has left a muslin in a bag in Hong Kong in August will confirm.

Rinse in cold water immediately, cold because hot water sets the protein, and get it into the wash the same day. A muslin over your shoulder every single time saves more clothes than anything else, and having far more muslins than seems reasonable is the real solution, and the only one I've found in forty years.

I have five children and ten grandchildren, and the only piece of equipment I've ever recommended without reservation is a large stack of thin cloths within reach of wherever the feeding happens.

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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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