Key Points

• In infants and children, the signs and symptoms of gastroesophageal reflux disease (GERD) may be atypical, including irritability, poor feeding tolerance, respiratory symptoms, and failure to thrive.
• Clinical history, response to treatment, and pH monitoring with or without impedence studies are the mainstays for diagnosis while contrast esophograms and endoscopy with biopsy can be important adjuncts for surgical decision-making.
• Primary management is non-surgical and includes feeding modifications (e.g., positioning, eating habits, and food composition) and pharmacotherapy.
• Surgical management of GERD in infants and children has changed dramatically over the recent period as fewer and fewer fundoplications are performed.