Gastroesophageal reflux

1. Big picture

Gastroesophageal reflux (GER) is very common in infants and is usually physiological. The key exam skill is to distinguish the “happy spitter” from the child with gastroesophageal reflux disease (GERD) or another dangerous cause of vomiting.

The safest clinical logic:

Infant/child with regurgitation or vomiting
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Is the child thriving, comfortable, and without red flags?
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Yes → physiological GER → reassurance + feeding advice
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No → GERD or alternative diagnosis
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Look for warning signs: bilious vomiting, forceful vomiting, weight loss, GI bleeding, neurologic signs, respiratory compromise
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Investigate and treat according to severity and suspected c