Feeding difficulty in infants is multifactorial and frequently misattributed to reflux. Using laryngomalacia as a framework, this talk explores the interaction between airway obstruction, suck–swallow–breathe discoordination, dysphagia and silent aspiration. It examines when instrumental swallowing assessment is warranted, how supraglottoplasty may influence feeding, and why persistent symptoms should prompt consideration of coexisting pathology, including a deep interarytenoid notch or laryngeal cleft. Current evidence for thickened feeds, interarytenoid injection and acid suppression is reviewed. A practical, multidisciplinary assessment pathway is presented, emphasising that feeding difficulty is a symptom—not a diagnosis—and that treatment must address the child’s physiology rather than appearances alone.