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Keady 1 presents some updated guidelines on the drug treatment of gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD). However, in order to provide clear management guidelines, we believe that the review should have first addressed the definition of GOR (ie, physiological) versus GORD (ie, pathological). In fact, the results of a recent survey on the knowledge, attitudes and practice styles of North American paediatricians regarding GOR show that many infants are still inappropriately treated for GORD when all they have is physiological GOR. 2 The first important goal of future educational efforts should therefore be directed to avoid over-treatment of "happy spitters" (ie, GOR). Secondly, in his conclusions Keady correctly...