Primary vesicoureteral reflux in children is associated with urinary tract infections and kidney damage. Bacteria from urinary tract infections enter the bladder from the perineum through the urethra, and a small amount of bacteria is excreted. Large amounts of bacteria can cause cystitis. The vesicoureteral reflux carries the bacteria to the renal pelvis and causes an upper urinary tract infection, called nephritis, which can destroy kidney tissue in repeated or severe cases. Before starting treatment, the natural progression of reflux should be clear: 1. The milder the reflux, the higher the chance of self-healing; the chances of self-healing are about 80% to 90% for I and II degree reflux, about half for III and IV degree reflux, and as low as 10% for V degree reflux. 2. Before the age of 5 or 6, many refluxes will heal themselves with age. The younger the child, the higher the chance of self-healing, that is, the same severity of reflux, a one-year-old child has a higher chance of self-healing than a five-year-old child. 3. Reflux itself is harmless. The destruction of renal function requires the presence of both reflux and infection. 4.Long-term use of low-dose prophylactic antibiotics is not harmful. 5. The success rate of anti-reflux surgery is very high (95%). Therefore, treatment options should take into account i) the extent of reflux, ii) the age of the child, and iii) the presence of new or recurrent urinary tract infections (breakthrough infection) and new renal tissue destruction (requiring comparison of a series of isotope renograms) despite the use of prophylactic antibiotics. The American Urological Association, Pediatric Vesicoureteral Reflux Group, analyzed all of these factors and proposed a very detailed guideline, which I have simplified and synthesized into an easy-to-understand table for parents (Table 1).