Gastroesophageal reflux (GER) is the most common esophageal disease and the most common cause of vomiting in children. 80% of children with GER develop vomiting in the first week of life, with varying degrees of severity, mostly after eating, sometimes at night or on an empty stomach, and in severe cases in the form of ejections, mostly stomach contents, sometimes containing a small amount of bile. The vomit is mostly stomach contents, sometimes containing a small amount of bile, but also shows overflow of milk or vomiting foam, older children can show regurgitation, acid reflux, belching, etc. In children, GER is closely related to pediatric vomiting, asthma, prolonged bronchopneumonia, chronic cough, recurrent pneumonia, apnea of prematurity, recurrent oral ulcers, dysphagia, and paroxysmal cyanosis. GER occurs mainly due to reduced LES tone and diaphragmatic foot, transient lower esophageal sphincter relaxation, reduced clearance of the esophageal body, and delayed gastric emptying. It is generally believed that the LES is the primary anti-reflux barrier, while normal peristalsis of the esophagus, the terminal mucosal flap, the diaphragmatic esophageal ligament, the length of the ventral esophagus, the clamping action of the diaphragmatic foot muscle and the His angle also play a role in preventing reflux. If these anatomical structures are qualitatively or functionally diseased, gastric contents can reflux into the esophagus. GER examination and diagnosis 24h esophageal PH monitoring is the gold standard for GER diagnosis, but it is complicated and time-consuming to perform and not easily accepted by children. Therefore, the most common clinical practice is to use X-ray barium swallow with esophageal kinetic examination and 24h monitoring of PH value. Management and treatment of GER In very young children, try keeping him in a semi-erect position or holding him vertically or placing him in an infant car seat or backpack for 30 minutes after eating. Keeping him fully upright may put pressure on his stomach and make him vomit again. Do not turn your child upside down on your lap or make him too active immediately after he has eaten. GERD vomiting is significantly reduced when lying on the stomach (prone) or facing left in a raised 30-degree bed, but seek your doctor’s advice before trying this method, because the prone sleeping position increases the risk of sudden infant death (SIDS), so you must carefully consider the pros and cons of this method before trying it. These methods have failed, and persistent reflux vomiting can lead to weight loss, dehydration and other health problems in children, so pediatricians may recommend surgical treatment when medication and feeding instructions fail.