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Pediatric anatomy

Potential implication

Airway maneuver

Large head & occiput

May push head forward and occlude airway

Shoulder roll may be required to align airway axes.

Large tongue

May occlude upper airway in obutnded or paralyzed patient

Jaw thrust, oro ornasopharyngeal airway, miller blade may have to be used.

Superior larynx and cords

Make visualisation of cords difficult

Shoulder roll may be required to align airway axes, straight laryngoscope to lift the epiglottis.

Cricoid narrowing

Subglotiic space is narrowest portion of the pediatric airway, prone to inflammation and upper airway obstruction

Monitor cuff inflation pressure in small childrens.

Large adenoids and tonsils

May cause upper airway obstruction; may bleed with nasal intubation

Avoid blind nasal intubation in young children.

Small cricoid cartilage

Makes cricothyrotomy technically difficult.

Needle cricothyrotomy preferred in young children.

Large stomach, low gastroesophageal sphincter tone, relatively small lungs

Insufflation of stomach with bag-valve mask ventilation or swallowed air can compromise respiratory status and prone for vomiting.

Consider early placement of orogastric or nasogastric tube to deflate stomach using positive ventilation in obtunded patient.