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Besides the pat on the back, effective burping requires two actions: holding baby in an upright position and applying pressure on baby's tummy (parents often forget this latter step). You seldom see a baby being burped in non-Western, breastfeeding cultures. The belief that babies need burping after feedings, or help "bringing up the wind," originated with the spread of bottle-feeding. The faster flow of milk from bottle nipples forces babies to gulp air in between closely-spaced swallows. Breastfeeding infants have fewer problems with air in their tummies. They can control the flow of milk at the breast and so they suck with a slower rhythm that allows them to better coordinate breathing and swallowing. Also, breastfed babies tend to be fed in a more upright position and enjoy smaller, more frequent feedings – other conditions that lessen the swallowing of air. Yet, even breastfed babies need to be burped occasionally, especially if they are fast feeders and/or mother has a strong milk ejection reflex.

To lessen the likelihood that baby will swallow air at the breast, feed baby in the upright position (at a 45 degree angle or greater). Help baby comfortably keep a tight seal during latch-on by supporting the weight of your breast and by wrapping baby around you rather than letting baby dangle away from the breast. Watch for signs that baby needs to burp during or after a feeding: she may balk at going to the other breast or she may squirm and grimace when you lay her down; there may be a painful expression on her face. If baby is content, the need to burp is past—if she needed to burp at all. Don't feel you have failed if you don't manage to bring up a burp after every feeding. Babies often don't need to burp with snack-type feedings; after a big meal, it's usually worth putting in some patient effort until baby burps. As babies get older and more proficient at feeding, burping becomes less of an issue. Try these burping positions:

• Over-the-hand burp. Sit baby on your lap and place the heel of your hand against her tummy, with her chin resting on the top of your hand. Lean baby forward, resting most of her weight against the heel of your hand to provide counter pressure on her tummy, and pat her on the back to move up the air bubbles.
• Over-the-shoulder burp. Drape baby way up over your shoulder so that your shoulder presses against her tummy, then rub or pat her back. Hold baby securely by hooking your thumb under her armpit. If she's on your right shoulder, do this holding with your right hand.
• Over-the-lap burp. Drape baby over one thigh (legs crossed or spread) so that it presses upward against her tummy. Support baby's head with one hand while you pat or rub her back with the other hand.
• The one-arm burp. This position is particularly helpful when you're busy and baby needs to burp. You can simply stroll around the house and have one hand free. The only drawback is that spit-up may go on the floor or down over your arm and baby's legs.
• Sling burping. If the air just won't come up, place baby upright against your chest and wear her in a sling until the air comes up.
• Nighttime burping. Burping is often not necessary during night feedings, since babies feed in a more relaxed manner and therefore swallow less air. If a trapped air bubble seems to be causing nighttime discomfort, you can avoid sitting up and going through the whole burping ritual by draping baby up over your hip as you lie on your side.
• Burp and switch. Some babies are more comfortable if they burp when changing sides. Getting the air up makes room for more milk. This can help avoid large spit-ups when a bubble gets trapped under the milk.
• Knee-to-chest burp. Sometimes babies need help not only getting air out the top end, but also out the bottom. The knee-chest position (flexing baby's knees up against her chest) helps baby pass excess gas.

( add illustrations on page 67 and 68 of Breastfeeding Book)