The differential diagnosis for lower esophageal strictures is Barret's esophagus, scleroderma, and strictures secondary to neoplastic growths, all of which are less likely in children.

The first treatment option for esophageal strictures is balloon dilatation. Surgery is reserved for cases where balloon dilatation is unsuccessful. 

Since the length of the stricture is relatively large in this particular patient and there is a possible risk of esophageal perforation, surgery rather than balloon dilatation was considered.