Spitting up is a common occurrence for newborns and is usually not a sign of a more serious problem. After feeding, try to keep the infant calm and in an upright position for a little while. Keep a burp towel handy, just in case. Contact your health care provider immediately if your infant:

• Is not gaining weight
• Is spitting up so forcefully that stomach contents shoot out of the infant's mouth
• Spits up green or yellow liquid, blood, or a substance that looks like coffee grounds
• Has blood in the stool
• Shows other signs of illness, such as fever, diarrhea, or difficulty with breathing

Some parents worry that their infant will spit up and choke if they are put to sleep on their backs, but this is not the case. Healthy infants naturally swallow or cough up fluids—it's a reflex all people have. Where the opening to the windpipe is located in the body makes it unlikely for fluids to cause choking. Babies may actually clear such fluids better when on their backs.

The NICHD's Safe to Sleep® Campaign (formerly the Back to Sleep campaign) recommends placing infants to sleep on their backs to reduce the risk for sudden infant death syndrome (SIDS). Since the recommendation for back sleeping began in 1992, the number of fatal choking deaths has not increased. In fact, in most of the few reported cases of fatal choking, an infant was sleeping on his or her stomach.

Anyone who's ever taken care of an infant knows that babies spit up. And spit up. And then spit up again.

It's easy to understand why some parents and other caretakers are concerned. Is the infant getting enough nourishment? Is frequent spitting up a sign of a more serious illness? Does the baby need medicine to treat the problem?

According to Andrew E. Mulberg, M.D, a pediatrician and pediatric gastroenterologist at the Food and Drug Administration (FDA), frequent spitting up is absolutely normal in most cases and not a symptom of poor health. As long as the child is alert, reasonably content, gaining weight, and not showing other signs of illness, this is not usually a cause for concern, he says.

So what is causing the baby's food to come back up so frequently?

In infants, the ring of muscle between the esophagus and the stomach—the lower esophageal sphincter (LES)—is not fully mature, allowing stomach contents to flow backward, Mulberg explains. In time, the LES will mature and open only when the baby swallows and will remain tightly closed the rest of the time, keeping stomach contents where they belong.

"By the time the child is 18 months of age or younger, the problem—known as gastroesophageal reflux (GER)—usually resolves itself," Mulberg says.

In a small number of cases, a more serious condition known as GERD (gastroesophageal reflux disease) may exist. GERD also can cause excessive spitting up, but requires treatment to avoid additional health complications, such as tissue damage in the lining of the esophagus. A health care professional should be consulted immediately if a baby shows such symptoms as spitting up blood, blood in the stool, weight loss, failure to thrive including lack of weight gain and persistent coughing or wheezing, Mulberg says.

Many parents are worried enough to try over-the-counter (OTC) medications, including proton pump inhibitors (PPIs) such as Prilosec. PPIs work by reducing the amount of stomach acid made by glands in the lining of your stomach and are often used by adults to treat GERD, commonly known as heartburn.

However, PPIs sold over the counter are not approved by FDA to treat reflux in infants, says Mulberg.

An FDA advisory committee met in November 2010 to discuss four clinical trials investigating the effects of PPI treatment of infant GERD. The committee concluded that PPIs should not be prescribed as therapy for otherwise healthy infants less than 1 year old, Mulberg says, unless there is evidence of tissue erosion in the esophagus.

As for what drugs may or may not be needed, that's a determination the health care professional must make after conducting a thorough physical examination. Mulberg suggests that parents should be ready to discuss the baby's mealtime behaviors in some detail, as well as the child's general mood. Before an appointment, parents should be prepared to answer questions such as:

• Does the baby spit up at every feeding?
• How much liquid is the baby spitting up?
• Are you breast-feeding?
• If not breast-feeding, what type of formula are you using?
• Have you recently switched formulas?

Once a more serious disease is ruled out by the health care professional, there are a number of things parents and other caretakers can do to help prevent babies from constantly spitting up. These include:

• Holding the baby in an upright position when feeding.
• Feeding the baby smaller portions at a time.
• Making a switch to a different formula.

"It's understandable why new parents, especially, are worried when their child seems to be spitting up nonstop," Mulberg says. "Generally, the parents are pretty sleep deprived, too—which doesn't help the situation."