Achalasia presents a diagnostic challenge in children, given the varied presentations. High clinical suspicion is necessary, particularly when treating infants and young children. The mainstays of diagnosis are barium swallow and manometry, each with findings highly suggestive of achalasia. Once the diagnosis is made, the most efficacious treatment is surgical esophagomyotomy. As the operative experience in children progresses, laparoscopic Heller myotomy emerges as the surgical treatment of choice, with or without an added fundoplication. Balloon dilatation or BoTox injection should be reserved for addressing postoperative recurrence of dysphagia. Medical treatment with calcium channel blockers currently has only very limited application in children.


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