The purpose of this study was to investigate the relationship between aspiration, as identified by videofluoroscopic swallowing (VFS) study, and pneumonia in children with suspected dysphagia. Data were retrospectively collected and analysed from 142 children referred for VFS over a one-year period. The median age was 33 months. Aspiration was identified in 44 per cent of the children studied. A history of pneumonia within one year of the VFS was found in 35 per cent. Aspiration, gastro-oesophageal reflux, and age one year or less were significant risk factors for pneumonia. Children with traumatic brain-injury were at less risk for pneumonia than all other children with suspected dysphagia. These results lend objective support to the previously suspected relationship between aspiration and pneumonia in this patient population.