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The sniffing position can be maintained by placing a towel or other object beneath the shoulders. Despite good head position, a child's hypotonic mandibular tissues may still allow the relatively large tongue to occlude the airway posteriorly. This can be relieved by a chin lift or jaw thrust that elevates the mandible anteriorly and separates the tongue from the posterior pharyngeal wall. The jaw-thrust technique is preferred in a child with a possible cervical spine injury, because it minimizes the movement of the neck while allowing maintenance of a neutral position of the cervical spine. If these maneuvers are unsuccessful, an oral airway or endotracheal tube should be considered.

NASOPHARYNGEAL AIRWAY Nasopharyngeal airways tend to be less useful in children because of the small nasal passages and the presence of hypertrophic adenoid tissue in the posterior nasopharynx, which is easily traumatized when inserting a nasopharyngeal airway.

ORAL AIRWAY Oral airways, which should be used only in unconscious children, are most useful in patients who require a continuous jaw thrust or chin lift to maintain airway patency. Oral airways are inserted with a tongue depressor to push the tongue into the mandible so that the airway can be inserted under direct vision.

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