Basic Airway Management in Children

Basic airway management in children is a life-saving skill that every healthcare provider should master. Children’s airways are smaller, softer, and more likely to get blocked. Even minor swelling or incorrect positioning can quickly stop airflow. That’s why basic pediatric airway management is a critical skill for healthcare providers. 

Among children who experienced cardiac arrest in the emergency department (EDCA), respiratory failure was a key factor, accounting for 5% of cases. This shows how often breathing problems play a critical role in pediatric cardiac arrest. So, keep reading to learn about the step-by-step approach to basic pediatric airway management.

 

Pediatric Airway Anatomy: Key Differences from Adults

Managing pediatric airway is often more difficult than an adult’s. Because their airway is smaller and shaped differently, it can be blocked more easily. Being aware of airway anatomy for children is essential for providing safe care.

Smaller and Narrower Airways

Children’s airways are narrow. The tightest spot is at the cricoid cartilage, which is just below the vocal cords. In adults, it’s at the vocal cords themselves. Because the airway is so small, even slight swelling or mucus can make it hard for a child to breathe.

Higher and Forward Larynx

In children, the larynx (voice box) sits higher and more forward. This makes airway access and management trickier than in adults.

Larger Tongue in a Small Mouth

A child’s tongue takes up more space in their mouth compared to an adult’s. This makes blockage more likely, especially if the child is unconscious.

Larger Head and Neck Positioning

Children have proportionally larger heads. This can tilt the airway in a way that blocks breathing if the head is not positioned correctly.

Softer, More Flexible Cartilage

The cartilage in a child’s airway is softer and bends more easily. Without proper support, the airway can collapse during breathing.

 

How to Assess Pediatric Airway Step by Step

Children account for over 30 million emergency department visits annually in the U.S., so pediatric airway problems are a common ED challenge. Assessing the airway in children is a critical part of medical and emergency care. Before positioning an infant or child’s airway, it is always best to check for any visible obstructions, such as food or small objects. Here’s a step-by-step checklist for you: 

Step 1: Medical History

Ask about past breathing problems, surgeries, or medical conditions. Note things like craniofacial abnormalities, neurological disorders, frequent chest infections, sleep apnea, or smoke exposure.

Step 2: Visual Check

Look at the face, neck, and mouth for swelling, injury, or anything unusual. Check the size of the mouth opening and the tongue. Watch for nasal flaring, chest retractions, or drooling.

Step 3: Mouth and Throat

See how wide the mouth opens. Fewer than three fingers are limited. In older children, use the modified Mallampati score to judge how much of the throat you can see. Also check the chin-to-thyroid distance (thyromental distance).

Step 4: Neck Movement

See if the child can bend the neck forward and backwards. Limited movement can make it harder for pediatric airway positioning.

Step 5: Breathing

Listen for wheeze, stridor, or no breath sounds. Feel for air at the nose or mouth. Watch the chest rise and fall.

Step 6: Risk Factors

Note features that can make the airway more difficult, like a small mouth, large tongue, or syndromes such as Pierre Robin or Treacher Collins.

Step 7: Emergency Check

If it’s urgent, focus on whether the airway is open and air is moving. Noisy or labored breathing usually means partial blockage. No sound or no breathing suggests complete blockage and needs immediate action it can also lead to respiratory arrest.

Read more: Benefits of Getting PALS Certified

 

Pediatric Airway Obstruction: Common Causes

In children, an airway can become blocked when something stops or limits air from reaching the lungs. Since their airways are smaller and softer than those of adults, even a minor blockage can turn serious quickly. Knowing the common airway pediatric obstruction causes helps parents, caregivers, and healthcare workers spot problems early and respond the right way.

Congenital Causes

Some airway problems are present from birth and show up early in life.

• Small jaw or underdeveloped facial bones (Pierre Robin sequence, Treacher Collins syndrome) can make the tongue fall back and block the airway.
• Blocked nasal passages (choanal atresia) make it hard for newborns, who mainly breathe through their nose, to get enough air.
• Narrowing below the vocal cords (subglottic stenosis) or thin membranes (laryngeal webs) can restrict airflow.

These conditions may cause noisy breathing, feeding difficulties, or breathing struggles soon after birth.

Infectious Causes

Infections are a common reason children develop airway blockages.

• Croup (a viral infection) causes swelling in the voice box and windpipe. This leads to a barking cough and noisy breathing, also called stridor.
• Epiglottitis (a bacterial infection) can quickly close the airway and is a true emergency. Warning signs include high fever, drooling, and trouble swallowing.
• Tonsillitis or deep neck infections may also cause swelling that narrows the airway.
• Spotting and treating these infections early is critical to prevent severe blockage.

Foreign Body Aspiration

Young children often put objects in their mouths. Sometimes these slip into the airway. Common examples include peanuts, coins, small toy pieces, or bits of balloons. If this happens, it can cause sudden choking. Suffocation and choking remain leading causes of injury death in infants; suffocation was a top injury cause for children under 1 in recent national data. 

Allergic Reactions and Injuries

Severe allergic reactions and certain injuries can also block the airway.

• Anaphylaxis (a serious allergic reaction) can cause swelling that closes the throat within minutes.
• Smoke inhalation or burns can injure the airway lining, causing swelling and breathing difficulties.

Injuries to the neck or face may cause swelling or structural damage that interferes with breathing.

Fast emergency care in pediatric emergencies is essential to secure the airway in these situations.

Long-Term (Chronic) Causes

Some conditions cause airway obstruction over time rather than suddenly.

• Enlarged tonsils and adenoids are the most common cause, often leading to snoring, restless sleep, or sleep apnea.
• Scarring and narrowing (subglottic stenosis) may develop after repeated intubation or trauma.

These causes often show up gradually but can still have a major impact on breathing and quality of life.

Read more: Everything You Want To Know About Online PALS Certification

 

Pediatric Airway Positioning Techniques for Safe Management

Airway positioning is one of the most important skills in pediatric care. Because children’s airway anatomy differs from adults, proper positioning of the head and neck is critical to keep the airway open and allow normal breathing. Correct techniques can prevent obstruction caused by the tongue or soft tissues falling back and blocking airflow.

Head Tilt–Chin Lift

This is the most common pediatric airway management method to open a child’s airway. Place one hand on the forehead and gently tilt the head back while lifting the chin upward with the other hand. This action moves the tongue away from the back of the throat and allows air to pass more freely. The movement should be gentle, as infants are more sensitive to excessive neck extension.

Jaw Thrust

When a neck injury is suspected or if the head tilt–chin lift is not effective, the jaw thrust is used. Place your fingers behind the angle of the lower jaw and push it upward without moving the neck. This lifts the tongue and soft tissues off the airway while protecting the spine.

Sniffing Position

The sniffing position helps align the oral, pharyngeal, and laryngeal passages for better airway access. Place a small rolled towel or blanket under the child’s shoulders, then gently extend the neck so the head tilts back slightly. The ears should line up with the sternal notch horizontally. This position is commonly used for ventilation or intubation.

Lateral (Recovery) Position

Placing a child on their side is known as the recovery position. This keeps the airway clear if the child is unconscious but still breathing. This prevents the tongue and secretions from blocking airflow and lowers the risk of aspiration.

Use of Basic Airway Adjunct

Sometimes, simple devices can be used to keep a child’s airway open. An oropharyngeal (oral) airway works when the child has no gag reflex, while a nasopharyngeal (nasal) airway is useful if the mouth can’t be used. Both devices help by stopping the tongue from falling back and blocking the throat.

 

Pediatric Airway Safety: Tips and Mistakes to Avoid 

Managing a child’s airway takes care and attention. The steps may seem simple, but even small mistakes can cause serious problems. Keeping these safety points in mind helps make the process safer and more effective.

Safety Tips

• Pick the right airway adjunct size for the child’s age and anatomy.
• Use a gentle head tilt or jaw thrust, without overextending the neck.
• Keep a proper mask seal during bag-mask ventilation so each breath goes in effectively.
• Watch the chest rise with every breath to make sure the child is being ventilated correctly.

Common Mistakes to Avoid

• Forcing an airway adjunct that is too large, which can cause trauma.
• Ventilating too quickly or forcefully, leading to gastric insufflation and aspiration.
• Neglecting to reassess the airway position after every intervention.
• Failing to recognize early signs of obstruction.

 

Pediatric Airway Management: Skills That Save Lives

In children, airway problems can become dangerous in just a few minutes. Their airways are smaller and softer. Even a little swelling or blockage can stop them from breathing properly. That is why people who care for children need to be confident in handling the airway.

Good training makes a huge difference. It builds confidence and helps you act without delay, giving a child the oxygen they need when it matters most. Want hands-on training in pediatric emergencies? Our PALS certification course prepares you to handle airway management confidently. Enroll Now.