Naturalistic mealtime interactions between a child with complex communication needs and her caregiver (focus dyad) and a child without disabilities and her caregiver (comparison dyad) were investigated. An activity-based communication analysis was used to outline the contextual background factors of the dyads' activities, and the dyads' conversational topics were analyzed. For the child and her caregiver (the focus dyad), the natural mode of communication at mealtime was unaided. Communication mostly concerned immediate mealtime issues. Other, shorter, topics were introduced but were also anchored to immediate issues. In contrast, the child and caregiver who comprised the comparison dyad conversed about a variety of personal topics that extended beyond the present. Topic patterns are exemplified using discourse excerpts and are discussed in relation to aided communication and development.