From examinations and clinical observations of 40 infants and a varying number of children from 2 to 11 years who all had characteristic symptoms of gastroesophageal reflux (GER), an attempt was made to establish the diagnostic contribution of esophageal manometry and long-term pH monitoring. A correlation between decreased resting pressure (less than or equal to 12 mmHg), or a sphincter insufficiency, and the degree of reflux symptoms was completely absent in infancy and increased only very slightly in young children. The most influential pH monitoring parameters were reflux during sleep, beyond 2 h postprandial, and during crying. These correlated most with the symptoms in infants. On the other hand, clinical developments were independent of the extent of the pH monitoring findings.