Paeds · acute-care-resuscitation-and-toxicology

Airway assessment and basic airway management

Also known as Paediatric airway management · Basic airway management in children · Bag-valve-mask ventilation in children · Airway opening manoeuvres · Airway adjuncts in children

Fellowship guide to paediatric airway assessment and basic airway management: how the child's airway differs from the adult's, recognising the threatened and the failing airway at the bedside, head tilt-chin lift and jaw thrust, sizing and selecting oropharyngeal and nasopharyngeal airways, and effective two-person bag-valve-mask ventilation, with escalation triggers to a definitive airway.

high12 referencesUpdated 16 July 202616 min readVerification in progress

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RACP DWEMRCPCH TheoryABP General Pediatrics

Red flags

A child whose stridor softens, whose effort falls, or who becomes drowsy and bradycardic is obstructing, not improvingSnoring in an unconscious child means the tongue is occluding the airway and will progress to complete obstructionSilence at the airway of a sick child is either a clear airway or complete obstruction; feel for air at the mouth to tell them apartAn oropharyngeal airway in a child with a gag reflex provokes vomiting and aspirationA nasopharyngeal airway must be avoided in suspected basilar skull fracture or coagulopathyOne-person bag-valve-mask ventilation with a poor seal causes gastric insufflation, regurgitation, and aspirationPersisting with failing basic airway technique instead of escalating delays the definitive airway

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

ed-acutewardpicunicudelivery-roomretrievalrural-remote

Clinical exam formats

written-only

Board mappings

Opens and maintains a child's airway using head tilt-chin lift and jaw thrustSelects and sizes oropharyngeal and nasopharyngeal airways correctlyPerforms effective two-person bag-valve-mask ventilationRecognises the difficult paediatric airway and anticipates the child who will be hard to mask-ventilateLeads escalation from basic airway techniques to a definitive airway with anaesthetic and intensive care supportApplies age-specific anatomy and physiology to airway decision-making in infants and childrenInitial airway assessment and basic airway management of an unconscious or obstructed childCorrect positioning and adjunct selection for the paediatric airwayTwo-person bag-valve-mask ventilation techniqueBedside recognition of the threatened and the failing paediatric airwayStepwise escalation of basic airway management and the decision to call for helpCommunication of an airway emergency and the immediate planLevel 1: Assesses and opens a child's airway using basic manoeuvres and adjunctsLevel 2: Performs effective bag-valve-mask ventilation and recognises deteriorationLevel 3: Leads the airway response and coordinates escalation to a definitive airwayDifferences between the paediatric and adult airway and their clinical significanceIndications, sizing, and complications of oropharyngeal and nasopharyngeal airwaysTechnique and complications of bag-valve-mask ventilation in childrenStructured airway assessment of a child using look-listen-feelDemonstration of airway manoeuvres, adjunct sizing, and mask ventilationSafety-netting and communication when the airway is threatenedRecognition and basic management of the obstructed paediatric airwayAge-appropriate airway positioning, adjunct selection, and bag-valve-mask ventilationRecognition of the difficult airway and timely escalationPerforms basic airway manoeuvres and adjunct placement in infants and childrenDemonstrates effective bag-valve-mask ventilation with a two-person techniqueRecognises airway deterioration and escalates to definitive airway managementCanadian approach to paediatric basic airway assessment and managementAge-based airway anatomy, positioning, and adjunct sizingBag-valve-mask ventilation technique and escalation pathways

Your progress

Saved locally on this device.

Practise this topic

Target exams

RACP DWEMRCPCH TheoryABP General Pediatrics

Red flags

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

ed-acutewardpicunicudelivery-roomretrievalrural-remote

Clinical exam formats

written-only

Board mappings

Overview & Definition

A child who is unconscious, obstructing, or not breathing will die of a blocked airway long before any other problem is addressed, which makes opening and ventilating that airway the single most decisive thing a clinician can do in the first minute of paediatric resuscitation. Basic airway management is the set of immediately available, non-invasive techniques that achieve this before any tracheal tube or supraglottic device is placed. It rests on three skills: opening the airway with a manoeuvre, keeping it open with an adjunct, and ventilating it with a bag-valve-mask. [1]

Because most paediatric cardiopulmonary arrests are respiratory rather than primary cardiac, competent basic airway management is the skill most likely to prevent the arrest altogether. A child whose airway is opened and ventilated early often recovers dramatically, and the airway and breathing that follow it determine whether circulation ever has a chance. [3]

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You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References12Show ledger

[1]Joyner BL Jr Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2025.PMID 41122891
[2]Van de Voorde P European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation, 2021.PMID 33773830
[3]Maconochie IK Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2020.PMID 33084393
[4]Holzki J The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Paediatr Anaesth, 2018.PMID 29148119
[5]Garcia-Marcinkiewicz AG Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry. Br J Anaesth, 2023.PMID 37076335
[6]Nemeth M Guedel oropharyngeal airway: The validation of facial landmark-distances to estimate sizing in children - Visualisation by magnetic resonance imaging (GUEDEL-I): A prospective observational study. Resuscitation, 2023.PMID 36702339
[7]Soleimanpour M Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) - E-C (dominant hand). J Cardiovasc Thorac Res, 2016.PMID 28210469
[8]Castro D Oropharyngeal Airway. StatPearls [Internet], 2026.PMID 29261912
[9]Atanelov Z Nasopharyngeal Airway. StatPearls [Internet], 2026.PMID 30020592
[10]Bucher JT Bag-Valve-Mask Ventilation. StatPearls [Internet], 2026.PMID 28722953
[11]Fiadjoe J Pediatric difficult airway management: current devices and techniques. Anesthesiol Clin, 2009.PMID 19703672
[12]Stein ML Emerging trends, techniques, and equipment for airway management in pediatric patients. Paediatr Anaesth, 2020.PMID 32022437

Airway assessment and basic airway management

Also known as Paediatric airway management · Basic airway management in children · Bag-valve-mask ventilation in children · Airway opening manoeuvres · Airway adjuncts in children

high12 referencesUpdated 16 July 202616 min readVerification in progress

Practise this topic

Overview & Definition

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References12Show ledger

[1]Joyner BL Jr Part 6: Pediatric Basic Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2025.PMID 41122891
[2]Van de Voorde P European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation, 2021.PMID 33773830
[3]Maconochie IK Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation, 2020.PMID 33084393
[4]Holzki J The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Paediatr Anaesth, 2018.PMID 29148119
[5]Garcia-Marcinkiewicz AG Difficult or impossible facemask ventilation in children with difficult tracheal intubation: a retrospective analysis of the PeDI registry. Br J Anaesth, 2023.PMID 37076335
[6]Nemeth M Guedel oropharyngeal airway: The validation of facial landmark-distances to estimate sizing in children - Visualisation by magnetic resonance imaging (GUEDEL-I): A prospective observational study. Resuscitation, 2023.PMID 36702339
[7]Soleimanpour M Comparison of four techniques on facility of two-hand Bag-valve-mask (BVM) ventilation: E-C, Thenar Eminence, Thenar Eminence (Dominant hand)-E-C (non-dominant hand) and Thenar Eminence (non-dominant hand) - E-C (dominant hand). J Cardiovasc Thorac Res, 2016.PMID 28210469
[8]Castro D Oropharyngeal Airway. StatPearls [Internet], 2026.PMID 29261912
[9]Atanelov Z Nasopharyngeal Airway. StatPearls [Internet], 2026.PMID 30020592
[10]Bucher JT Bag-Valve-Mask Ventilation. StatPearls [Internet], 2026.PMID 28722953
[11]Fiadjoe J Pediatric difficult airway management: current devices and techniques. Anesthesiol Clin, 2009.PMID 19703672
[12]Stein ML Emerging trends, techniques, and equipment for airway management in pediatric patients. Paediatr Anaesth, 2020.PMID 32022437