Science of the burp: understanding aerophagia and eructation in newborns

Abstract

Infantile colic and regurgitation are common benign causes of distress in infants, often leading caregivers to employ burping after feeds despite limited scientific evidence of its efficacy. Burping is widely believed to release swallowed air, reduce regurgitation and minimise colic; however, current research does not support its benefit for colic prevention. We summarise in this report common burping techniques, their mechanical basis and implications for infant care. This brief review highlights the lack of standardised guidelines and underscores the need for well-designed studies to clarify the role of burping in modern neonatal practice. Burping after feeding is commonly advised by medical care providers like paediatricians, nurses, relatives and parenting websites, even though the scientific evidence for the efficacy of burping is lacking. There is no literature on various techniques of burping and the benefits associated with each. The only literature on burping efficacy showed no benefits. Burping is a widely practiced caregiving routine in newborn care, believed to release swallowed air, reduce regurgitation and minimise colic. Despite its near-universal application, scientific evidence supporting the efficacy of burping in healthy term infants remains limited and conflicting. Caregivers employ various burping techniques based on cultural traditions, paediatric advice and experiential knowledge, yet there is no clear consensus or standardised guideline to recommend one method over another. This review aims to summarise and evaluate the commonly practiced burping techniques, examining their mechanical principles, practical considerations and potential benefits or limitations for newborns and caregivers.

Introduction

Burping is a long-standing and widely practiced caregiving technique in newborns, intended to release swallowed air and reduce discomfort, colic and regurgitation. Despite its routine use across cultures, the scientific evidence supporting the efficacy of burping in reducing colic or regurgitation remains limited and mixed. Recent randomised controlled trials suggest that while burping is a common practice, it may not significantly lower colic episodes and could even increase regurgitation in healthy term infants.¹,⁵

In neonatal care, particularly in the neonatal intensive care unit, feeding intolerance, gastro-oesophageal reflux (GER) and delayed gastric emptying are critical concerns that can impact an infant’s growth, development and length of hospital stay. Nurses often turn to non-invasive techniques such as positioning to support feeding tolerance, with right lateral positioning believed to enhance gastric emptying and left lateral positioning favoured for reducing GER symptoms.⁶ However, the complex interplay of gastric motility and reflux in individual infants often requires a nuanced approach.

This review article aims to critically examine the current evidence on burping techniques in newborns, explore the physiological basis behind their use and integrate findings on complementary strategies such as positioning. By synthesising available research, we hope to clarify the role of burping in modern neonatal practice and identify gaps where further investigation is needed to optimise care for both healthy and at-risk infants.

This report is not intended as clinical guidance but rather as a concise, evidence-based commentary to highlight the gap between widespread burping practices and limited empirical support. By summarising current knowledge and identifying areas requiring further research, we aim to stimulate academic and clinical discussion rather than issue practice recommendations.

Discussion

Each burping technique is built on principles of anatomy, gravity and motion, aiming to aid the passage of swallowed air from the stomach through the oesophagus. While the over-the-shoulder method remains the most popular due to its adaptability, sitting and prone techniques offer alternative options depending on caregiver preference, the infant’s condition and contextual factors. For infants with gastrointestinal challenges, such as slowed gastric motility or GER, positioning strategies drawn from broader neonatal nursing practices suggest that the right lateral position may enhance gastric emptying, while the left lateral position may reduce reflux episodes. However, it is important to note that burping techniques and positioning are not interchangeable; their mechanisms and intended effects differ, and infants may present with overlapping digestive issues that complicate straightforward recommendations.

Despite the widespread cultural and clinical reliance on burping, robust research evidence comparing these techniques is lacking. Studies examining the incidence of colic and regurgitation have not shown significant reductions associated with burping, and some evidence suggests that certain techniques may even increase regurgitation episodes. The walking burp, while soothing, introduces physical strain that may not be sustainable for all caregivers. Ultimately, decisions about which burping technique to use are often guided by caregiver experience, infant comfort and contextual factors rather than clear scientific directives.

Evidence gap

Despite widespread cultural reliance on burping, robust comparative studies are absent. The only randomised control trial (71 dyads) demonstrated no reduction in colic and a significant increase in regurgitation.⁵ Observational data highlight heavy reliance on family traditions rather than healthcare professionals, underscoring educational gaps.⁷

Clinical implications

• Healthy infants: no strong evidence that burping prevents colic or reduces regurgitation.

• High-risk infants (GER, feeding intolerance): positioning strategies may play a larger role than burping.

• Caregiver considerations: over-the-shoulder and sitting techniques are versatile; walking or prone methods may impose higher demands or risks.

Overview of burping techniques

The main burping techniques employed by caregivers can be grouped into six approaches. In the over-the-shoulder method, the infant is positioned upright against the caregiver’s shoulder with the chin supported while the back is gently patted, a technique adaptable to sitting, standing or walking.⁸,¹⁰ In the face-down across the lap technique, the infant is laid prone across the caregiver’s lap with the chin supported, offering stability but requiring the caregiver to remain seated.⁸,¹⁰ The sitting upright on the lap method involves seating the infant on the caregiver’s lap with chest support and gentle chin stabilisation, leaning the infant slightly forward while patting the back to balance upright posture with forward tilt.⁸,¹⁰ In the prone on flat surface approach, the infant is placed tummy-down on a flat surface with the head turned to one side, allowing the caregiver to pat the back but requiring close airway monitoring. The walking or bouncing burp technique consists of holding the infant upright while the caregiver gently walks or bounces, providing soothing rhythmic motion, though it can be physically demanding. Finally, the over-arm burp (Tiger hold) involves laying the infant prone over the caregiver’s forearm with head support, applying gentle abdominal pressure that may ease colic or gas but requiring caregiver confidence and skill (table 1).

Table 1. Summary of common burping techniques in infants.

Technique	Description	Advantages	Challenges
Over-the-shoulder	Infant held upright against caregiver’s chest, head supported, gentle pats	Natural upright position; comforting contact	Requires good head control; spit-up risk on caregiver
Sitting on lap	Infant seated on caregiver’s lap, chin supported, leaned forward	Eye contact; less tiring	Requires neck support; variable effectiveness
Lying across lap	Infant prone across lap, chin supported	Relieves belly pressure; good for gassy infants	Less upright; may be less effective for burping
Prone on flat surface	Infant tummy-down, head to side	Flexibility; soothing pressure	Airway monitoring essential; limited safety
Walking/bouncing burp	Infant upright while caregiver walks or bounces	Soothing, rhythmic motion	Physically demanding for caregiver
Over-arm (tiger hold)	Infant prone over forearm, head supported	Gentle abdominal pressure; good for colic	Requires skill; tricky positioning

Conclusion

Burping remains a nearly universal part of newborn care, yet its continued use is largely rooted in cultural tradition rather than evidence. Current data, including the only available randomised controlled trial, indicate no benefit in preventing colic and a possible increase in regurgitation episodes. This review highlights the mechanical diversity and practical considerations of common burping techniques while reinforcing that no standardised, evidence-based guideline currently exists. Future studies should aim to delineate whether specific subgroups of infants, such as those with feeding intolerance or reflux, might benefit from targeted approaches and whether caregiver-reported comfort has measurable physiological benefits.