Introduction Swallowing dysfunction occurs when a child has difficulty organising food or liquid in the mouth. As breathing and eating share passageways, problems with sensory awareness, muscle strength, timing and co-ordination can lead to unsafe swallowing. Given the complex needs of children who are at risk of aspiration, each child and his family will require a wellcoordinated team to manage their unique situation. Swallowing safety is of prime importance and indicators of difficulty are described later in the chapter.