Paediatric airway anatomy, equipment sizing, and ETT selection

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Target exams

Red flags

• The infant desaturates rapidly after apnoea: a reduced functional residual capacity and a resting oxygen consumption more than double the adult value make the safe apnoea time short. Preoxygenation is essential.
• The paediatric larynx is high and anterior (taught: infant C3 to C4, adult C5 to C6), the tongue is large relative to the oral cavity, and the epiglottis is long, floppy and U-shaped. A straight (Miller) blade and a different laryngoscopy technique are often required.
• The paediatric larynx is narrowest anatomically at the subglottic level and functionally at the cricoid cartilage; an uncuffed tube that passes the cords can still obstruct at the cricoid.
• Laryngospasm is the canonical paediatric airway crisis: it escalates from partial obstruction to complete closure, bradycardia, and arrest within minutes if unrecognised (taught cascade).
• A concurrent upper respiratory tract infection raises the risk of laryngospasm (OR 2.03), and an airway anomaly raises it further (OR 3.35).