Is Burping a Baby More Habit Than Help?

by ParentCo. March 08, 2017

Although I never had one of my own, I watched the commercial enough times to know exactly how to care for a Baby Burpee. Twenty-five years later, I still know that patting her on the back "really makes her feel so much better," even though she has long ago been supplanted by more realistic crying and wetting dolls. Burping is such a reflexive action that we might not even think about why we do it. You feed the baby. You burp the baby. But why do we burp babies? What do parenting manuals have to say about the practice? And whom does burping benefit more: the baby, or its caregivers?

Contradictory advice on burping

When I'm looking for a deep dive into parenting advice, I turn to the American Academy of Pediatrics' mammoth "Caring for Your Baby and Young Child". Weighing in at just under 1,000 pages, this book covers all the developmental milestones from birth to age five and describes treatment for most common and many uncommon conditions children may have. Its entry for "burping, hiccups, and spitting up" offers the following advice:

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, it may be helpful to stop the feeding rather 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 change of position alone will slow her gulping and reduce the amount of air she takes in.

This advice, or some version of it, is the advice most of us would probably give if asked about burping. But it's not the only advice out there. Michael Cohen's "The New Baby Basics" is much lighter than the AAP's manual and takes a decidedly lassiez-faire approach to parenting. Cohen's simple, alphabetized format makes it a wonderful guide for middle-of-the-night reassurance about a host of common issues. The book is, in essence, a comprehensive list of things not to worry about. Cohen's entry for burping, for example, begins with the assertion that burping is "not all that important." Cohen explains:

Burping happens when the stomach releases air that was swallowed while feeding or crying. Newborns don't often burp, since they eat slowly and sleep most of the day, allowing little chance for air to enter the stomach. Bottle-fed babies tend to ingest more air, because artificial nipples aren't as easy to seal a little mouth around. Therefore, as a good rule of thumb, if there's no air, there's no burp. So don't go pounding on Lucy's back for hours in search of audible results. And if she drifts off after a meal, you might as well let her sleep; even if you don't tap, the air will still make its way up, if less dramatically.

While the AAP advises parents to burp their babies even if their babies seem comfortable, Cohen advises parents to leave them alone.

The medical case for burping

Cohen suggests that former feeding practices are in part responsible for the pervasiveness of the "burping myth." When parents were instructed to feed their infants set amounts of formula, babies often ended up vomiting. Out of that vomiting arose concerns that babies would choke on vomit. Instead of changing the amount babies were being fed, parents burped the babies. Now that the general practice is to feed babies on demand, Cohen argues, there's generally no need to burp them. There is some evidence to suggest that babies with underdeveloped lower esophageal sphincters may need to be burped, because in those babies burping is thought to help keep food in the stomach. But babies with perfectly well developed esophageal sphincters (that is, babies who are not doing "Exorcist" style projectile vomiting after feedings) do not need help keeping food in their stomachs. The two main medical reasons offered for burping otherwise healthy babies are that 1) colic is improved with regular burping and that 2) burping reduces the risk of SIDS. Neither of these conditions has been effectively linked to the presence or absence of burping. A recent study comparing babies who were burped and babies who were not burped found no differences in colic between the two groups. Mother-child pairs were randomized to a burping or no burping group. The study was small, enrolling only 71 mother-child pairs, but its findings are intriguing. In addition to finding that burping did not appear to affect rates of colic, the study also found that babies who were burped actually experienced higher rates of regurgitation than babies who were not burped. Burping has also been connected to Sudden Infant Death Syndrome (SIDS) because of a 2007 article in the journal "Medical Hypotheses". The problem with this connection is that it was, as the journal's title suggests, a hypothesis. "Medical Hypotheses" has been a significant source of controversy, because, up until 2010, the articles in it were not peer-reviewed. It's important to note that, despite this article's priority in internet search results, no peer-reviewed study has proven that either the presence or absence of burping is a contributing risk factor to SIDS deaths.

Why burping persists

Cohen's advice against burping runs counter to every family member and stranger who interacted with my child. I didn't regularly burp him, but he was often burped, reflexively, by everyone else who held him. So why are we still burping babies in the absence of strong medical evidence? Burping may not have a medical function, but it may serve an important psychological function for caregivers. In his commentary on the above study of burping and colic rates, physician Ahmed Rashid writes: "There can be few more frustrating consultations than those with first-time parents trying to manage infantile colic. The desperation in their sleep-deprived voices can make it extremely difficult not to offer some intervention." This focus on exhausted parents puts advice about burping into a new perspective. What if burping is not for the baby, but for that baby's caregivers? Observe the following two sentences: "The baby was burped" and "The baby burped." In the first sentence, the baby had something done to it: A caregiver burped it. In the second sentence, the baby's in control: He or she burped. What if we imagined these two sentences as parenting philosophies? The first sentence, reflected in the advice from the AAP, suggests that babies need parents to do everything on their behalf. It also indirectly offers the powerful encouragement that parents can do something in the wake of colic or other similar situations. The second sentence, reflected in Cohen's advice, suggests that letting a child burp on its own (or not) offers the tiniest bit of agency to the tiniest of humans. Choosing to not burp the baby, then, can be one step in a long process of helping a child gain incremental independence. But Cohen's advice is cold comfort for parents up at all hours with a screaming infant. It asks them to accept that, sometimes, there's nothing a parent can do to calm a screaming baby. Just like Baby Burpees – some of whom are still out there being burped – today's babies are probably going to be burped. Perhaps that's because burping is a ritual for parents, making us feel that we have some measure of control over our otherwise chaotic first years with our babies.

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