Necrotizing enterocolotis (NEC) is a common cause of morbidity and mortality in infants that are born prematurely. The exact cause of NEC is not known. Clinical correlations between the use of thickened fluids and the development of NEC have been established. Thickened fluids are commonly used for the treatment of symptoms from both dysphagia and gastroesophageal reflux disease (GERD) in fragile infant populations. Despite its frequent recommendation, there is little empirical evidence to support the use of thickened fluids in pediatric populations for the treatment of dysphagia or GERD. There is emerging evidence to support the use of slower flowing bottle/nipple systems and side lying feeding position to support safe oral intake in infant populations. Speech-language pathologists who work in neonatal intensive care units and who work with other fragile infant populations must be aware of the risks associated with the use of thickened fluids in these populations and be prepared to provide alternative treatment options as appropriate.