Last reviewed 01/2018

The airway may be adequately protected by the procedures of basic life support, but if there is concern about the patency and protection of the airway, a few adjuncts may be used.

The simplest is an oropharyngeal Guerdel airway. A guide to the size to use is to lay it against the child's face. The correct size should extend from the mouth to the angle of the jaw. When inserting this airway, in small children it should be inserted with convex side upwards, using a tongue depressor or small laryngoscope blade to guide the tongue out of the way. In older children the usual method of inserting the airway convex side down and then rotating it into position. Nasopharyngeal airways have little role in paediatric resuscitation.

To protect the airway an endotracheal tube may be passed, particularly if there is coma from head injury; if prolonged artificial respiration is necessary ; or if a subject with impaired consciousness is to have a nasogastric tube passed. Inserting an endotracheal tube must not interrupt basic life support for more than 30 seconds. Internal endotracheal tube size in millimetres may be calculated in children above the age of one year as [(age/4)+4]. Alternatively tube size may be selected using the child's little finger or nostril aperture as a guide. In newborn infants size 3 to 3.5 are usual. Additionally uncuffed tubes are preferrable as the cricoid ring is narrow in children and may be damaged.

Over the first two years of life the upper airway structures are higher and more anterior than in the adult, so when placing an enotracheal tube in infants a straight bladed laryngoscope is easier, with a more curved blade being better for older children.

In cases of facial injury or upper airway obstruction, a tracheostomy may be indicated.