Gastroesophageal reflux (GER) and GER disease (GERD) are common problems in children and adults. Most infants with GER achieve symptomatic resolution by 1 year of age and are not thought to develop GERD later in life; most adults tolerate intermittent symptoms of heart-burn and nerve develop complications of GERD. Recent data suggest that some children who have persistent GER in infancy may develop symptoms of reflux in preadolescence. Similarly, when symptoms of reflux begin after the age of 2 years, concerns are raised that these symptoms could be early manifestations of GERD later in childhood, adolescence, or as an adult. Identification of children and adolescents with GERD, who may become adults with GERD or experience complications of GERD, is a significant challenge for practitioners. Implementation of safe and effective therapies is essential for not only improving symptoms and quality of life but also preventing long-term complications of GERD in adulthood.