Question: I have a 16 month old toddler who was born full term at 38 weeks, 4 days by precipitous vaginal delivery. He had a sustained heart rate in the 60's for the last 7-10 minutes of labor that returned to normal at the time of delivery with APGARs of 8 and 9. He had dysphagia at birth, with overt aspiration during bottle and breast feeding and a swallow study at 28 days that demonstrated deep penetrations with everything except honey thickened liquids. He was weaned off thickened liquids at 6 months and now tolerates some fork-mashed foods but has oral-motor delay. He was also diagnosed with GERD by his pediatrician at 2 weeks though an impedance study at 8 weeks demonstrated only 72 episodes of reflux in a 24 hour period with little correlation to symptoms, and he had an EGD at 1 year with biopsies that was unremarkable. Reflux symptoms - coughing/sneezing/yawning during feeds, frequent spit-up - are well controlled with Prevacid. He is speech delayed and only babbles with 'mamama' and 'nanana' syllables at this time, but has met gross and fine motor milestones. He has had newborn and 1 year audiology testing that demonstrates no hearing deficit. He had three episodes of otits media between 8 and 10 months of age. He also has a h/o grade 4 VUR bilaterally and a right sided UPJ obstruction that was corrected by dismembered pyloplasty at 6 weeks. His follow up 1 year renal u/s showed mild persistent hydronephrosis on the side of the repaired UPJ obstruction. Parents are concerned that he has had sleep difficulties since birth requiring an incline for the first 6 months then waking frequently with distressed crying several times per night. Pt reportedly holds himself in an arched position during wake-ups with legs held outstretched and does not like to be picked up, pushing at and striking caregivers if they attempt to console him. He has also been having daily fevers in the 101-102 range for the past 3 months during which he is more fussy and clingy though they happen only in single episode spikes, do not occur at the same time of day everyday, resolve with Tylenol and Motrin and are not associated with any other symptoms. He has had multiple negative urine cultures, negative blood cultures drawn during febrile episodes, mildly elevated inflammatory markers - ESR 33, CRP 3.5, negative CXR, negative ANA and normal CBC and differential. He has had allergy skin testing for food and environmental triggers that have been negative. Is there any diagnosis that could encompass the dysphagia, developmental delay, GERD like history without objective findings, sleep disturbance as well as recurrent fevers?