Nine babies with pure oesophageal atresia were treated in our institution in the years 1979-1996. All received a feeding gastrostomy as their initial operation. After initiation of gastrostomy feeds seven (78%) developed gastric complications, including two posterior gastric perforations (one fatal). We propose that the high complication rate is due to a small, abnormal stomach that is vulnerable to damage by operative trauma and the effects of handling large volumes of feed. We hypothesise that the stomach is abnormal because it has not been exposed to the maturing effects of amniotic fluid in utero. Feeds should be introduced very cautiously to these babies and built up very slowly.