Gastroesophageal reflux (GER), a problem rarely mentioned half a century ag
o, has now become a major source of blame for a number of pediatric maladie
s. Over the past few decades, the rate of GER diagnosis in hospitalized inf
ants less than 1 y old rose more than 10-fold. An increased rate of diagnos
is does not mean that GER disease is more common. The increase in diagnosis
may be the result of overdiagnosis, inappropriate diagnosis or an increase
d ability to detect GER. However, it is also possible that increased GER di
agnosis may reflect a real increase in the prevalence of pathological GER a
nd GER disease. Three aspects of infant rearing have changed dramatically d
uring 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 infa
nt rearing and their possible relationship with increased GER.