Positioning in the infant seat (“chalasia chair”) for treatment of infants with gastroesophageal reflux is presumed to have a beneficial effect. We undertook a controlled, prospective study of such positioning to evaluate this purported benefit. Nine infants with documented gastroesophageal reflux participated in 18 paired two-hour postprandial trials in an infant seat and in the horizontal prone position. Distal esophageal pH monitoring demonstrated longer exposure to gastroesophageal reflux while infants were in the seat than when they were prone (28.2±6.4 per cent vs. 12.8±3.7 per cent of total time with pH <4.0, P = 0.023), a difference due largely to more episodes (16.0±2.4 vs. 10.1±2.3 per two-hour postprandial period, P = 0.002). We conclude that the infant seat, rather than being therapeutic in gastroesophageal reflux in children under six months of age, is actually detrimental, when compared with simply placing an infant prone. (N Engl J Med 1983; 309:760–3.) GASTROESOPHAGEAL reflux is a disorder that affects many children. It may produce vomiting with failure to thrive, esophagitis with eventual stricture, pulmonary aspiration with pneumonia, and probably reflex bronchospasm and laryngospasm, potentially causing asthma or apnea.1 In addition, many infants have a benign developmental form of gastroesophageal reflux, which causes no morbidity but nevertheless is a concern to many parents and physicians. Positioning is part of the initial therapy for gastroesophageal reflux and the foundation to which other therapy is added.2 In adults, the maintenance of an upright sitting or standing posture and elevation of the head of the bed.
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