Will burping, pausing for 'rest and digest', or holding baby upright after feeds make your baby more settled?

Burping your baby after feeds doesn't help and can even make sleep worse (believe it or not!)

As strange as this is going to sound, you don't need to burp your baby, or hold her upright after feeds. Actually, most human cultures don't burp their babies. On the contrary, both burping your baby and holding her upright after feeds can make the days and nights much harder than they need to be, by unnecessarily disrupting sleep.

Feeding your baby dials him down. You can find out about this for breastfed babies here and bottle fed babies here. Offering frequent flexible feeds is one of your two baby-sleep superpowers, which makes the days and nights as easy as possible. But burping dials babies up, making sleep harder. Here are other things to know.

• You don't need to worry when your baby refluxes, as the reflux doesn't do harm or cause pain - but burping makes babies puke more, too. You can find out about this here.

• Your baby will swallow some small amounts of air, or perhaps generate small amounts of gas in the stomach as the milk is digested. You might even be able to feel her milk being swallowed down as you cuddle your baby to you during the feed. But we know from imaging studies that babies don't have significant amounts of air in their stomachs either as they feed or after feeds, even when they have feeding problems.

Your baby will release any stomach air in whatever position she has drowsed off in. You don't need to do anything. She will burp all by herself, if she needs to, often very loudly, whatever position she's in.

The usual burping positioning is not good for your baby's motor development

The usual burping positions on your lap are not the best for your baby's motor development. This is because

• Holding your baby out on your lap, away from the support of your own chest and abdomen, means that your baby's spine collapses over on itself in a c-shape. Your baby hasn't developed adequate core stability yet for this posture.

• Supporting your little one under the chin suspends your baby's body from his cervical spine, no matter how gentle you're being. This posture is also not the best for your baby's motor integration and development.

You can find out about how best to support your baby's motor development here and here, and why the strategies that are ideal for motor development are also very good for healthy sleep.

Holding your baby upright against your shoulder after feeds doesn't help and can even make sleep worse

Feeling that you need to hold your baby upright after a feed can be hard work, without benefits for your baby.

• From a biological perspective, the upright position turns on an arousal response in the brainstem, the most archaic part of the brain.

• Being upright also doesn't help your baby better digest the milk.

• There's no reason to try and stop your baby from refluxing, since the reflux is harmless and it doesn't matter if your baby pukes up some milk.

What really matters is that we make the nights, and the days, just as easy (and as enjoyable) as possible. Below the video, you can read a story about how one family found their life was so much easier when they stopped burping their baby.

You might have heard that your baby needs 'rest and digest' time lying over your lap in the middle of a breastfeed or feed, but this isn't true

You might have heard that you should give baby 'rest and digest' time by lying him over your lap, between offering the first breast and before offering the second. You might have heard this if you're bottle feeding, too.

But 'rest and digest' time is completely unnecessary, and may be especially disruptive if you have an unsettled baby. It's true that your little one might enjoy any kind of postural change and stretch after being in the one position for a period of time at the breast, but there's no need to do this in any particular way.

Here are other things to know about the 'rest and digest' advice.

• Most often, babies are happy to go straight to the other breast. If not, your baby has had enough for now and it's time to get on with the day!

• You don't need to think of a breastfeed as a meal-time, when you're supposed to get as much milk in as you possibly can to have a settled baby. Thinking about breastfeeds this way can actually backfire and cause problems, like fussiness at the breast or conditioned dialling up. You can find out about the benefits of frequent, flexible (often short) feeds, which dial your baby down, even from just one breast, here

• All you need to do is tune in to your baby's little signs and communications, and do what suits you at the time. 'Rest and digest' advice shifts your attention away from making everything as easy as possible, and can be disruptive to baby sleep because it interferes with your own easy, relaxed experimenting, as you fit breastfeeding in around lots of rich sensory motor nourishment for baby and you, outside the home.

If something works for you, there's no need to change it. But the more instructions breastfeeding women receive which lack evidence of benefit, the harder everything seems to become!

A story about burping baby Daisy

Eleven week old Daisy fretted and backarched and pulled back from the breast since birth. Her parents had been told she had gas pain. Everyone recommended her mother take her off the breast regularly to burp her. Even though Daisy often grizzled and cried when they did this, her worried parents thought she was upset from the wind.

Someone else suggested she had air-induced reflux or food intolerance. Last week, their osteopath told them Daisy swallowed a lot of air with feeds because of tongue-tie, and a lactation consultant referred her for laser surgery. The lactation consultant also said that this was why Daisy woke so much at night and resisted going to sleep, and that they needed to burp her in between feeds and at the end of every feed, and to hold her upright for at least 20 minutes and preferably for half an hour after feeds as well.

Daisy's parents came to me for a second opinion. When I checked their little one over, I could see a membrane running some way along the under-surface of her tongue. But normal baby oral anatomy is highly variable, and Daisy had all the function she needed to transfer milk successfully.

When her mother breastfed her, I could see she was not in a stable position. This was why Daisy fussed and back arched so much during feeds! We worked together to correct the way her mother's breast dragged off in a direction different to the direction of the vacuum she created inside his little mouth as he suckled. Before we knew it, she was enjoying the most stable and contented breastfeed they'd ever had.

"I know from the research," I explained, "that babies - even when they have feeding problems - are not swallowing large amounts of air at the breast or bottle."

Then I gently explained to these exhausted parents, who had been trying so hard to do the right thing by their little girl, that most human cultures don't burp their babies.

Burping is part of the routinised, sleep-training approach to infant care so popular in the West. Burping after feeds rouses a baby's nervous system, which fits with the (mistaken) idea that you're not supposed to let your baby fall asleep with the breast or bottle so that you avoid 'bad sleep habits'. But it is biologically normal for babies to dial down into a relaxed and sleepy state due to the neurohormonal effects of milk and mealtime. Letting babies fall asleep with feeds doesn't set up bad sleep habits, despite what you might hear, but can make the whole sleep thing a lot more difficult than it needs to be!

"Burping Daisy won't help her sleep better, either," I said quietly. "It's normal for babies to wake every couple of hours at night into toddlerhood. What matters is that everyone gets back to sleep quickly." Daisy's parents looked at me skeptically.

"We're so tired we can't think," her father muttered eventually, glancing at Daisy's mother.

"If your little one wakes the minute you put her down during the day, it's not because of gas or wind: it's because a tiny nap took the edge of her rising sleep pressure, which was all she needed, and now she is ready for more daytime sensory adventure. If she wakes every hour or more for whole parts of the night, it's not because of gas or wind: it's because her sleep pattern is disrupted and we need to work with her biological sleep regulators to align her sleep better with yours. If your little one grunts and groans and writhes half the night, so that you can hardly sleep, it's not because of gas or wind: it's because her sleep pressure is no longer high and her circadian clock is disrupted. Again, we need to work with her sleep regulators to make the nights more manageable."

Daisy's parents still didn't look entirely convinced, but they were willing to hear me through to the end.

"Rousing up out of sleep activates the gut, which is why your baby might pass flatulence or puke or burp with all that grunting and groaning in the night. The gut is like a second brain, highly innervated, and when a baby rouses, you'll often notice baby gut events. These can be ignored. We don't need to burp or hold the baby upright - or swaddle or wrap for that matter. And try not to change her nappy unless you absolutely have to! In fact, doing these things in the night can be a recipe for severe sleep deprivation, as you may find yourself awake for an hour or more each time the baby wakes."

When we followed up two weeks later, they told me excitedly how their life with Daisy had completely changed. They were using a range of strategies which we'd discussed from The Possums Sleep Program, as well as the gestalt approach to fit and hold, and couldn't believe the difference. Daisy's mother gazed down, amazed, as her little one snuggled in calmly against her breast and body, feeding as we talked, suck-suck-suck-suck-suck-swallow. Suck-suck-suck-suck-suck-suck-suck-swallow.

"All that burping we did, day and night!" she said, tears slipping over her cheeks. "If only I'd known sooner!"

Recommended resources

The burp and puke chat. A podcast by Dr Pamela Douglas with Emma McCabe

Selected 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 and Development. 2014;41(1):52-56.

Mills N, Lydon A-M, Davies-Payne D, Keesing M, Mirjalili SA, Geddes DT. Imaging the breastfeeding swallow: pilot study utilizing real-time MRI. Laryngoscope Investigative Otolaryngology. 2020;5:572-579.