A case study of a child with Charcot-Marie-Tooth type 1 (CMT1) that presented with bilateral vocal fold paralysis. This is the first case of bilateral vocal fold paralysis in a child with CMT1 and it is the first case to be managed endoscopically. The surgical decision making process is discussed, and in particular the role of fiberoptic endoscopic evaluation of swallowing (FEES) in determining what surgical options should be entertained. In children with bilateral vocal fold paralysis who also have other neurologic abnormalities, the clinician should consider the possibility of CMT as the cause.