Changes in consonant and syllable-level error patterns of three children diagnosed with childhood apraxia of speech (CAS) were investigated in a 3-year longitudinal study. Spontaneous speech samples were analyzed to assess the accuracy of consonants and syllables. Consonant accuracy was low overall, with most frequent errors on middle- and late-developing sounds. Omissions and substitutions were the dominant error types. Analysis of syllables revealed higher frequencies of error on complex mono- and polysyllables. Multiple regression analyses revealed that consonant accuracy is predicted by syllable shape accuracy and polysyllable frequency. Improvement was noted over time, although irregular patterns of consonant and syllable-level errors persisted across the period studied. Findings suggest that consonant errors in CAS are related to syllable-level deficits, namely difficulty constructing syllabic frames for speech production targets. Learning outcomes: On the basis of this article, the reader will be able to (1) describe the deficits in consonant production demonstrated by the participants, (2) analyze the relationship between consonant production and syllable-level patterns of error and (3) consider the value of addressing syllable construction as a therapeutic goal.