Increased gastroesophageal reflux in infants: can history provide an explanation?

Gastroesophageal reflux (GER), a problem rarely mentioned half a century ago, has now become a major source of blame for a number of pediatric maladies. Over the past few decades, the rate of GER diagnosis in hospitalized infants less than 1 y old rose more than 10-fold. An increased rate of diagnosis does not mean that GER disease is more common. The increase in diagnosis may be the result of overdiagnosis, inappropriate diagnosis or an increased ability to detect GER. However, it is also possible that increased GER diagnosis may reflect a real increase in the prevalence of pathological GER and GER disease. Three aspects of infant rearing have changed dramatically during the past 50 y: what infants are fed, how much they are fed and where they are placed between feedings. This essay examines these aspects of infant rearing and their possible relationship with increased GER.