Version July 2025
| Symptoms suggesting GERD |
| Discomfort or irritability (if this is the only symptom in an infant, it is unlikely to be due to GERD) |
| Heartburn, chest pain, or epigastric abdominal pain |
| Recurrent hematemesis |
| Acid brash, regurgitation (often triggered by recumbent position, food, activity, or anxiety), or "wet burps" |
| Nocturnal cough |
| Chronic sore throat |
| Rapid relief of symptoms when taking antacids or acid-suppressing medications |
| Dystonic posturing (Sandifer syndrome) |
| Wheezing, stridor, or hoarseness |
| Symptoms increase after large meals |
| Constipation |
| Signs suggesting GERD |
| Erosion of tooth enamel, mainly on the palatal aspects of the maxillary teeth |
| Unexplained iron-deficiency anemia |
| Esophagitis, esophageal stricture, or Barrett's esophagus on diagnostic testing |
| BRUE |
| Asthma |
| Recurrent aspiration pneumonia |
| Recurrent otitis media |
| Symptoms less commonly attributable to GERD |
| Dysphagia or odynophagia* |
| Failure to thrive or weight loss |
| Feeding refusal/aversion¶ |
| School absences |
| Anxiety/depression |
| Marijuana use (heavy, daily use may be associated with hyperemesis) |
BRUE: brief resolved unexplained event; GERD: gastroesophageal reflux disease.
* Patients with dysphagia (difficulty swallowing) or odynophagia (pain with swallowing) usually should undergo a specific evaluation, as described in the topic text. In adolescents, odynophagia is often associated with pill esophagitis or caused by a Candida or viral infection of the esophagus.
¶ Food aversion may be associated with GERD in toddlers or eosinophilic esophagitis in young children. Psychosocial stressors should also be considered.