Aims: To describe the clinical characteristics and long-term outcomes of infants and toddlers who have required modified barium swallows (MBS) to assess their feeding issues. Methodology: Retrospective review of the records of children under 2 years of age who required an MBS between January 2010 and December 2023 at Sydney Children's Hospital, Randwick. Deceased patients and those with incomplete medical records were excluded. Caregivers were sent a questionnaire that included the Montreal Children’s Hospital Feeding Scale (MCHFS) and other questions to assess the current feeding method, ongoing feeding difficulty/aspiration and history of respiratory-related illnesses. Results: 491 patients were included (58% male). 73.5% required only one MBS with a mean age of 8.4 months at the first MBS study. The most common reasons for referral were noisy breathing (39.5%), cough during feeding (34.8%) and reduced suck/swallow/breathe coordination (21.6%). 20.2% had neurological co-morbidities. 58.5% had dysphagia. Aspiration was identified in 42% of patients, of which 87% were silently aspirating. The most common recommendations were no changes to diet (37.1%) and positional changes (25.5%). Of the 111/491 (22.6%) who completed the questionnaire, their average age was 46.9 months (range 3-142), and 59 patients (53.2%) were aspirators on their initial MBS. There was no statistical difference in rates of oral feeding (p = 0.45), parental perception of ongoing feeding difficulties (p = 0.56), rates of pneumonia or chest infection with no known cause (p=0.64) or ongoing feeding difficulties as per the MCHFS (p=0.173) between the aspirators versus the non-aspirators on follow-up. Conclusion: Children with swallowing difficulties and aspiration on MBS in early childhood appear to have similar outcomes (rates of oral feeding, respiratory-related illness, quality of life) over time to non-aspirators.