A variety of chronic and acute illnesses have been associated with GERD. GERD should be confirmed only after other major conditions have been ruled out. In infants, signs and symptoms obtained through a comprehensive feeding and nutritional history can establish the diagnosis (Kahn& Orenstein, 2011b). Diagnostic tests in older children or those infants and children not amenable to treatment include barium swallow examination, upper GI study, fiberoptic endoscopy, esophageal manometry, ambulatory pH studies, gastro esophageal scintigraphy (radionuclide scan), ultrasound, and chest computed tomography (CT).