Gastroesophageal reflux is common in infancy and childhood and a frequent cause of visits to the primary care and specialty office. Most infants and children who exhibit symptoms of reflux, such as regurgitation, vomiting, or discomfort, have uncomplicated reflux rather than gastroesophageal reflux disease. Despite this, the numbers of infants and children who receive treatment with acid suppression, undergo noninvasive or invasive testing is much larger than is warranted by their clinical course. The relative lack of response to acid suppression of some groups of patients including irritable infants, infants and children with extraesophageal symptoms, such as hoarseness, cough, or asthma prompted a reevaluation of the previously published guidelines (Table).