The majority of infants with GER have a mild problem that generally improves by 12 to 18 months of age and requires only conservative lifestyle changes or medical therapy. If GER is severe and remains unsuccessfully treated, multiple complications can occur. Esophageal strictures caused by persistent esophagitis with scarring are one of the most significant complications. Recurrent respiratory distress with pneumonia another serious complication, is an indication for surgery. Failure to thrive caused by GER can often be managed with medical therapy and nutritional support.