The Pediatric Airway

Before continuing, we will first examine some key differences between the pediatric and adult airway.

Anatomy

• Children have relatively large tongues, which may fall back and cause airway obstruction
• Larger tonsils and adenoids which may bleed with instrumentation
• Floppy, omega-shaped epiglottis
• Relatively anterior larynx
• Relatively narrow trachea. More resistance to flow for a given degree of airway obstruction
• Narrowest point of trachea is at subglottic level. Endotracheal tube may pass vocal cords but be too large for subglottis
• Shorter trachea which may result in endobronchial intubation
• Infants and small children have large occiputs. When lying supine the neck will be flexed which may contribute to airway obstruction. To address this, a shoulder roll can be placed under the scapula, as demonstrated in the following video