Anatomy

A child's airway is much smaller than an adult's, and the size varies depending on age. The anatomic and functional differences are more pronounced in infants and young children. The airway is higher and more anterior in a child's neck than in the adult's. The tongue and epiglottis are relatively larger and, thus, more likely to be an obstructing element in a child's airway. Infants younger than 6 months of age are primarily nasal breathers. Thus, keeping the nasal passages clear is vital in a young, spontaneously breathing infant. When a child is supine, the prominent occiput causes flexion of the neck on the chest, occluding the airway. This can be corrected by mild extension of the neck to the sniffing position. Overextension or hyperextension, acceptable for adults, causes obstruction and may kink the trachea, since the cartilaginous support is poor.

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