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Gastroesophageal reflux (GER) is a common condition in infants, thought to be the result of transient lower esophageal sphincter relaxations which occur independent of swallowing.  Most cases of GER are physiologic and generally resolve by early childhood. Gastroesophageal reflux disease (GERD) is diagnosed when symptoms persist or complications such as aspiration or esophagitis develop.  Currently there is wide practice variation in the surgical treatment of severe infant and childhood reflux with multiple acceptable surgical approaches chosen based on individual disease characteristics as well as surgeon preference.  In this review article we discuss the use of laparoscopic fundoplication, gastrojejunostomy and jejunostomy tube placement to mitigate the symptoms of GERD.  Although these minimally invasive techniques have greatly advanced treatment in infants and children, a paucity of data exists comparing outcomes of each technique, resulting in a lack of consensus on best technique.  Surgical approach to GERD treatment is an important area of research that needs further investigation.