Eighty-four high risk children were examined for suspected gastroesophageal reflux comparing 24-h esophageal pH measurements with ultrasound (US) scans with and without the use of color Doppler (CD). In 83.3 % of the patients there was unequivocal agreement (reflux or no reflux) among all three techniques; 60.7 % of the children showed reflux by pH-metry as compared to 51.2 % by B-mode US and 59.5 % by CD US. In 87 % of patients there was agreement between pH-metry and B-mode US as compared to 94 % between pH-metry and CD US. The sensitivity of reflux detection increased from 84.4 % to 98 % when CD was added to B-mode US. This improvement was thought to be due to the higher sensitivity of CD for rapid and small quantities of reflux. The small number of discrepancies between pH-metry and CD US is probably due to the inability of the former to detect neutral reflux of contents or short duration (< 30 s), while CD US may miss some cases of acid reflux due to the short time of the examination (10 min). The addition of CD increases the sensitivity of US for detecting reflux. This rapid, easy and reliable method can be used to screen high risk populations when reflux is thought to be the cause of respiratory symptoms.