Pediatric Associates of Richmond

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Digestion, Gas, Burping, Spit Up/Reflux, and Bowel Movements

Burping Babies

Whether breast or bottle feeding, babies swallow air, some more than others. Attempt to burp your baby once or twice during feedings. He may not always need to burp. If the baby seems to be guzzling a lot of air, or seems to be “full” before the end of the feeding, you may need to burp more often. Burping Techniques:

It is common for the baby to spit up a mouthful of milk when he burps.

Spitting Up, Reflux, and Vomiting

Most babies spit up after each feeding or while burping. Reflux is the medical term for spit up. We do not worry about spit up unless the volume is so great that babies fail to gain adequate weight; babies are having problems breathing (e.g. bluish discoloration around the lips); or unless spit up causes inconsolability.

To reduce spit up keep the baby upright and minimize vigorous play with the baby for about 30 minutes after feeding. More frequent burping may also be helpful or necessary. When laying the baby down to sleep, have the head of the bed elevated. Elevate the head of the bed by placing something under two legs of the bed or under the mattress. Never put something on top of the mattress to elevate your newborn’s head, as this increases the risk for SIDS.

Babies may have forceful “projectile” vomiting on occasion. If your baby does this frequently or repeatedly, you should inform one of our doctors or nurse practitioners.


Most babies have a moderate amount of gassiness. If the baby is burping well and passing gas easily, there is no problem. If, however, the baby is having a lot of stomach cramps and crying due to the gas, you should inform the doctor. Infant gas drops are safe to use and help many babies, but don’t help all.

Breastfed babies who are gassy or colicky may improve by making sure to empty the first breast completely before offering the second side. This pattern increases the percentage of hindmilk the baby receives. Hindmilk has higher fat content with less lactose. Sometimes high lactose containing milk causes bloating and gas.

Bowel Movements

Stools normally vary in both color and frequency. In the first few days the baby passes dark, tarry, pasty “meconium” stools. In 3 to 4 days, breastfed babies begin to pass yellow, seedy, mustardy stools. Breastfed babies will not have true constipation because of the make up of breastmilk. Occasionally, these babies will have infrequent stools as a part of the maturation process, such as around 4 weeks old. They do not require any adjustment in diet during this time. Bottle fed babies may pass green, brown, or yellow stools. Stools may occur after each feeding or only once every few days. The frequency is not that important. The stool consistency may be runny, soft, pasty or formed. All babies may strain a bit to pass a stool (have you ever tried to poop while lying down?). If the stools are not hard pellets and not causing a lot of pain and distress, they are okay. If they are hard pellets, you may add one teaspoon of Karo syrup to four ounces of formula twice a day. Do not use suppositories or enemas without consulting the doctor.