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Gastroesophageal reflux disease (GERD) in children is a condition in which liquid flows backward, or refluxes, out of the stomach and into the esophagus. The esophagus is a muscular tube that connects the mouth to the stomach. It passes through a muscle called the diaphragm, which separates the chest from the abdomen. The passageway through the diaphragm is a hole called the esophageal hiatus. The wall of the esophagus has slightly thickened muscle layers where it connects to the stomach. These muscle layers, combined with part of the diaphragm, form the lower esophageal sphincter. Normally when a child swallows food, the lower esophageal sphincter relaxes, allowing the food to pass through it. Then the lower esophageal sphincter contracts to prevent food from refluxing out of the stomach into the esophagus. Sometimes the lower esophageal sphincter may relax even when the child hasn't swallowed, allowing food already in the stomach to move back into the esophagus. This condition is called gastroesophageal reflux, and may have no symptoms or only mild heartburn. However if the reflux is severe, happens often, and causes more serious symptoms, the child has a condition called gastroesophageal reflux disease, or GERD. If the food refluxes into the esophagus, stomach acid mixed with the food can cause irritation. If the food refluxes all the way up the esophagus into the throat and down into the airways, irritation and infection of the airways can also happen. Although spitting up is normal, GERD may require a procedure called fundoplication. Before the procedure, the child will be given general anesthesia to put him or her to sleep during the procedure. A breathing tube will be inserted through the nose or mouth and down the throat to help the toddler breathe during the procedure. Commonly, the surgeon will make five tiny incisions near or in the belly button and on the right and left sides of the upper abdomen, and insert tubes for a camera and surgical instruments. Next, the surgeon will carefully find the lower esophageal sphincter near the entrance to the stomach. The esophageal hiatus may be tightened with sutures to prevent the stomach from slipping into the chest. The top, or fundus, of the stomach will be wrapped around the outside of the sphincter. The wrapped fundus will be sutured back on to the stomach to create a valve, which tightens and strengthens the sphincter. The fundoplication valve will help prevent stomach contents from refluxing back up into the esophagus. In some cases, the surgeon may insert a feeding tube, also known as a gastrostomy tube, into the child's stomach while the sphincter heels. This tube will deliver food directly to the stomach and allow trapped air to escape. Finally, the surgeon will close the incisions with disolvable sutures, or skin closure strips. After the procedure, the child will be taken to the recovery room for monitoring. Pain medication will be given. The child may continue to receive antibiotics through the IV. Within one to three days, the child will be released from the hospital. If the child has a feeding tube, the surgeon will remove it when he or she is able to eat normally.