Today Ryan had a swallow study and upper GI study done at Hackensack UMC. Hypotonia presents a very high risk of aspiration of liquid or food particles into the lungs. It stands to reason that if the muscles we can see on the outside are hypotonic then the muscles on the inside could well be too, preventing Ryan from swallowing effectively etc. As hes had a few serious lung infections in such a short period of time his pediatrician wanted to get an idea of how his swallow was. As the last chest xray taken in the hospital was still showing signs of illness the dr wanted to take another xray to see how his lungs looked now, after a couple of months. Turns out Ryan still is showing "scarring" on the lungs, and she advised we should see a pulmonologist to follow up. Ryan handled both the barium swallow study and upper GI test like a champ. From the tests the dr was able to tell us that his swallow looked fine in thin liquids, purees and crunchy textures although he had a very immature chew, and didn't use his tongue to move the food around inside his mouth. She recommended doing some oral motor therapy with him. He also has severe reflux due to a floppy sphincter muscle (or stomach valve) that is not closing properly therefore allowing food to come right back up after going down. She was surprised we weren't really seeing any signs of reflux, but he does hiccup alot, and spits up occasionally. My thoughts are that if the food is coming right back up then its not having time to get acidic therefore Ryan is not feeling the pain symptons usually related to GERD. The reflux however does pose an issue in that it can further cause aspiration and damage the lungs so we were advised to see a gastroenterologist to try to get it under control.