In this episode, hosts Dr. Peter Lu and Dr. Jason Silverman talk to Dr. Rachel Rosen about one of the most common problems we see as pediatric gastroenterologists (or as pediatricians): gastroesophageal reflux disease or GERD. She explains how she approaches the evaluation and management of babies who spit up frequently and why all that spits up is not GERD. We also talk about the care of older children and adolescents who have GERD, including those with GERD symptoms that persist despite a trial of acid suppression. She discusses the value of pH-impedance testing and also explains why she is cautious about recommending anti-reflux surgery.Dr. Rosen is a pediatric gastroenterologist at Boston Children's Hospital, Director of their Aerodigestive Center, and an Associate Professor at Harvard Medical School. She is also the first author of the 2018 NASPGHAN and ESPGHAN guidelines on the evaluation and management of children with GERD.Learning Objectives:1) Recognize the evolving definition of GERD in children.2) Understand the pathophysiology and management of GERD symptoms in infants.3) Understand the role of pH-impedance testing in the evaluation of children with GERD symptoms.4) Understand the role of anti-reflux surgery in the management of children with severe GERD.CME for NASPGHAN members is available here!Links:Rosen R, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology,Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018.As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Produced by: Peter LuSupport the showAs always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Follow us on Twitter, Facebook and Instagram for all the latest news and upcoming episodes!