Abstract Purpose Comparative outcomes of enhanced percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) have not been elucidated in infants. We describe the outcomes and procedural episodic expenditures of PEG versus LG in this high-risk population. Methods 183 gastrostomies in children under 1 year were reviewed from our institution spanning 1/2011–6/2015. Pertinent demographics and 3-month complications (mortality, gastrocolic fistula, reoperation, cellulitis, granulation, pneumonia, and tube dislodgement < 6 weeks) were collected. Facility and professional administrative data was used to conduct a charge and cost analysis of PEG and LG procedures as well as their statistically significant complications. Results 78 PEG and 105 LG infants were compared. LG infants were significantly younger, had higher ASA class, and increased frequency of cardiopulmonary disease. Significant major complications included a 3.8% incidence of gastrocolic fistula among PEGs (3.8% vs 0%, p = 0.04) and 7.6% early tube dislodgements among LG infants (0 vs. 7.6%, p = 0.01), resulting in $86,896 of additional charges with PEG complication. Incorporating complication frequency, average charges, and variable cost per case were $8964 and $253 greater using PEG. Conclusions Despite a healthier cohort, infants undergoing enhanced PEG have more morbid and costly complications. LG may be the less burdensome approach to gastrostomy in infants. Case–Control Study / Retrospective Comparative Study – Level III.