Although the defi nition of Gastro-Esophageal Refl ux Disease (GERD) has not changed much over the last ten years, GERD continues to cause high rates of morbidity and mortality. Probably, and in a practical way, it could be said that physiological GERD that is not pathological is usually accompanied by regurgitation, and that its main symptom is vomiting. As in acid peptic disease, in GERD we can talk about certain aggressive and protective factors that can cause damage depending on their prevalence. Signs and symptoms of GERD in children depend on the age of the group studied. Just as every wheezing child is not asthmatic, in gastroenterology not every child that vomits or regurgitates has GERD. Today, certain slowly evolving diseases and conditions are defi ned as refractory GERD because the natural history of these diseases and their association with increased morbidity and mortality result in prognoses that imply different therapeutic approaches. Sensitivity, specifi city and reproducibility vary in accordance to the laboratory tests requested to study a child with GERD. Treatment of children with GERD includes anti-refl ux measures, administration of medicine and surgery.