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The difficult pediatric airway

Nathan W Mick, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH


This topic will review conditions in children that can make airway management difficult, anatomic characteristics that may identify those conditions, and management strategies.

General principles of airway management in children, including rapid sequence intubation are discussed separately. (See "Basic airway management in children" and "Emergency endotracheal intubation in children" and "Rapid sequence intubation (RSI) outside the operating room in children: Approach".)


Effective airway management includes anticipating and planning for problems. Difficulties frequently occur as the result of patient characteristics that interfere with spontaneous breathing, bag mask ventilation, laryngoscopy, and/or intubation of the trachea. Identifying characteristics of the difficult airway and developing a plan for managing problems are essential principles of anesthesia practice [1]. These principles have been modified and effectively used to evaluate adults in the emergency department [2].

Children infrequently require aggressive airway management and difficulties do not often occur [3,4]. Many of the difficult airway predictors, particularly anatomic abnormalities, are more common in adults. As a result, evidence specific for children regarding identification and management of difficult airways is limited [5,6]. Nevertheless, a reasonable, systematic approach for children can be developed from experience with adult patients in the operating room and emergency department.


A difficult airway is generally defined as a situation in which a clinician experiences difficulty with face mask ventilation, laryngoscopy, or intubation [1,2]. In an emergency setting, this also includes difficulty performing an emergency surgical airway, such as needle cricothyroidotomy.

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Literature review current through: Oct 2017. | This topic last updated: Jul 31, 2017.
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