Snapshot An 8-month-old girl is brought to the pediatrician by her parents for a well-baby visit. The parents report that their only concern is that the patient "spits up" her food. The parents say that she is exclusively breastfed and denies any increased irritability, abnormal behavior, diarrhea, or vomiting. Physical examination is unremarkable. Parent education and recommendations are implemented. Introduction Clinical definition gastric contents going into the esophagus in the absence of pathologic consequences a normal physiologic process that occurs in infants, children, and adults note that gastroesophageal reflux disease (GERD) results in pathologic consequences (e.g., esophagitis) Epidemiology Incidence very common in infants and the frequency decreases with increasing age ETIOLOGY Pathogenesis transient lower esophageal sphincter relaxation Presentation Symptoms "spitting" up healthy infants are sometimes called "healthy spitters" Physical exam typically a normal physical exam Differential GERD symptoms failure to thrive feeding difficulties arching of the back irritability complications esophagitis Barrett esophagus strictures adenocarcinoma in severed GERD DIAGNOSIS Diagnostic criteria this is a clinical diagnosis Treatment Conservative increasing caloric density while decreasing feed volume indication may be helpful in patients with GER thickening feeds indication thickening the feeds with agents such as rice cereal will increase the caloric density of the feeds and may decrease reflux in GER Complications By definition GER is considered in the setting of reflux without pathological consequences Prognosis Uncomplicated GER has a favorable prognosis because the infant will "outgrow" the frequency of regurgitation