How to Burp a Baby with Low Tone, Reflux, or a G-Tube – 6 Positions That Actually Work

(The gentle, no-stress guide for babies who can’t tolerate the usual moves)

You try the classic over-the-shoulder pat and your baby either goes limp, starts arching, or the G-tube pulls.

Regular burping advice feels impossible.

Take a breath.

These are the exact 6 positions that PTs, NICU nurses, and hundreds of special-needs parents actually use — safe, effective, and zero fighting.

The 6 Positions That Actually Work

1. Chest-to-Chest Reclined (best for low tone & reflux) Recline at 45° with pillows → lay baby chest-to-chest, head on your collarbone. One arm supports whole trunk, other hand slow circles on back. Gravity + deep pressure = burp without strain.
2. Supported Football Hold with Pillow (low tone + G-tube) Place firm pillow or Boppy on lap → baby belly-down along forearm, knees tucked. Small rolled towel under chest keeps head higher. Light jiggle + left-side tummy pressure.
3. Side-Lying Burp (great for reflux & post-NICU babies) Lay on your side → baby tucked against you also on side. Support entire back with forearm, gentle press-release on upper back.
4. Seated Upright on Lap with Full Support (high tone or arching) Baby sits on your thigh facing away → one arm across chest under armpits, other hand pats. Keep hips flexed to reduce arching.
5. Prone on Therapy Wedge (OT favorite) 30° wedge on floor → baby tummy-down, arms forward. Stroke or vibrate up the back — many burp on their own.
6. Over-the-Shoulder with Extra Support (bigger babies or CP) Rolled blanket under chest → arms free → hold both legs together to prevent scissoring.

Quick science: Deep pressure + upright or prone positioning increases vagal tone and helps move gas without triggering tone or reflux. Vibration and slow strokes work better than hard pats in babies with neurological differences.

(Source: American Journal of Occupational Therapy, 2022)

“My daughter has Down syndrome and severe reflux. Chest-to-chest reclined is the only way she burps without screaming.”

— Mom in Down Syndrome Diagnosis group, 2024

Gear That Made a Difference for Parents

• Babocush cushion “Vibration + gentle incline — burped every time.”
• Nested Bean Zen Sack (light chest weight) “Mimics our hand — calmed startles and gas.”
• G-Tube pads / tube protectors “Kept the button from pulling during football hold.”

Your Burping Checklist

• Full head & trunk support
• Hips flexed (reduces arching)
• Slow circles or vibration > hard pats
• Keep G-tube secure
• Upright or prone only
• Stop if baby shows stress

You’ve got this.

One gentle burp, one calmer baby, one less worry at a time. ❤️