Findings from complete blood cell count, C-reactive protein, and chest radiograph were normal. He received a sepsis workup and antibiotics for 3 days until blood culture had negative findings. Investigation for nasopharyngeal reflux was initiated with barium esophagram, which showed reflux of contrast from the oropharynx into the nasopharynx and through the nostrils (Figure 1). Some contrast passed down the esophagus into the stomach, and an aspiration episode into the trachea was visualized (Figure 2). The infant underwent direct laryngoscopy, esophagoscopy, and bronchoscopy. No structural anomalies of nasopharynx, larynx, esophagus, or bronchi were present. Computed tomographic scans of the brain, neck, and chest were normal, showing no intrinsic or extrinsic structural obstruction to the esophagus or trachea. A 2-dimensional echocardiogram with Doppler flow study of the heart and major blood vessels did not reveal abnormal vessels or structural anomalies.