Esophageal thermal injury (ETI) is an uncommon occurrence in both children and adults. Therefore, little is known about the diagnosis and clinical course of patients suffering from these injuries. We present the case of an 11-year-old female with macrocephaly capillary malformation syndrome and developmental delay suffering from ETI after ingestion of a piece of hot butternut squash. Endoscopy revealed linear, white plaques consistent with thermal burns. Management involved respiratory support, local and systemic analgesia, antibiotics, and nasogastric tube feedings. Our case highlights the nuances and differences in diagnosis, endoscopic findings, and management of ETI in a pediatric patient.