Settling tummy pain

When and how do I burp my baby and settle tummy pain?

If your baby is suddenly in a lot of pain while breastfeeding or comes off the breast in pain, the baby may need burping or help with a tummy cramp. Babies that are sleeping after a feed do not. Some babies need more burping and others need less. Do what works best. We have found placing the baby against the mothers upper chest and shoulder and massaging the mid-back to be the most helpful treatment for tummy pain.

A) Reasons for helping babies burp and settle tummy cramps

Babies can have tummy pain caused either by gas in the tummy (stomach or bowels) or a tummy cramp and it can be hard to tell the two apart. Happily, they both are often settled by putting gentle pressure on the baby's tummy (burping). Burping does not appear to affect how often a baby cries but it can shorten the duration of the unhappiness (Kaur 2015).

Some parents will bicycle the baby’s legs to help the baby. Adults do not use this technique when they have painful cramps from diarrhea or need a burp and similarly we have not found it helpful for babies.

B) When to help the baby

Burp your baby if the baby:

  • Is suddenly in a lot of pain while breastfeeding.
  • Comes off the breast in pain.
  • Has tummy pain between feeds.

We have found that every baby is a little different. Some are helped by more burping and some need less. In general, babies may benefit from more burping when their mothers have a large milk supply. 

If the baby is asleep after a feed, the baby is not in pain, so there is no need for burping. Waking a baby to burp disrupts the baby’s sleep patterns and irritates the baby.

C) How to burp and settle tummy cramps

Effective burping is very dependent on using good technique. We have found the following very effective. 

We recommend placing the baby in an over-the-shoulder position and adding massage. To apply this using the right shoulder: 

  1. Turn the baby to face you.
  2. Place the baby’s tummy against your right upper chest. The baby’s chin should rest on your shoulder and the right side of the baby’s head should be lightly touching your right cheek. 
  3. Place your left hand under the baby’s bum and the palm of your right hand in the middle of the baby’s back.
  4. If the baby’s head needs support, lean to the left so the baby’s head can fall against your right cheek.
  5. Push the part of your palm next to your little finger a little more firmly up and into the baby’s back for one second and then bring the rest of your palm into the baby's back. The pressure should be like that of a gentle massage. Your hand creates a little upward roll to help the baby burp.
  6. Stop when the baby’s cry stops or becomes less intense. This usually takes 10 to 20 seconds.
  7. Take the baby down from the shoulder, look at the face, and see what the baby is telling you. Sometimes they say “I’m fine” by looking happy or they might say “I’m hungry” by giving hunger signs
  8. If they are hungry, return them to the breast.
  9. If they are still crying, burp the baby one more time. If the baby does not settle after two rounds of burping, consider other causes of crying. 

D) Reasons for the over-the-shoulder position

There are several different positions for burping babies:

  1. Over-the-shoulder: The baby is placed upright against the mother's chest and shoulder. The baby is supported by the mother's chest and by one hand under the baby's bum and the other against the baby's back. The side of the baby’s head should be lightly touching her cheek.
  2. On-the-lap: The baby sits on the mother’s lap. The baby is supported by the mother's hand placed on the tummy and chest. Some mothers will extend the thumb and pointer (index) finger to hold the baby's cheeks.
  3. Over-the-forearm: The baby is laid face down, across the mother’s forearm with her thumb and pointer (index) finger holding the baby’s cheeks and the baby’s legs hanging down on each side of the forearm.

When combined with massaging the baby's back, the over-the-shoulder position has major advantages over the other two.

1) The over-the-shoulder position vs the on-the-lap position

The over-the-shoulder position has the following advantages over the on-the-lap position:

  1. The baby is not bent over its full stomach.
    1. This leaves more room in the baby’s chest for the lungs to expand, which allows the baby to breathe steadily while being burped.
    2. This makes vomiting less likely.
  2. The baby’s head is upright instead of folded onto its chest. This also helps the baby breathe steadily.
  3. You can apply more pressure to the baby’s tummy.

2) The over-the-shoulder position vs the over-the-forearm position

The over-the-shoulder position has the following advantages over the over-the-forearm position:  

  1. The baby is upright, which allows air to escape the stomach.
  2. You can apply more pressure to the baby’s tummy.
  3. The pressure is more evenly distributed over the baby's tummy and not limited to the area under the mother's forearm.

E) Reasons for using massage for tummy pain and not back patting

Massaging the baby’s back has the following advantages over back patting:

  1. While patting is reassuring to babies, it is unlikely to decrease a pain severe enough to result in the baby crying.
  2. Massaging puts pressure on the stomach which:
    1. Will help the baby burp.
    2. Will help to decrease the pain of a tummy cramp.

Just like adults who wrap their arms over their tummies when they have cramps from diarrhea for example, pressure on the baby’s tummy will help to decrease pain.

References

Kaur, R, Bharti B, Saini SK. A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. Child Care Health Dev. 2015; 41: 52–56.