Little differences: Paediatric airway anatomy
When it comes to anatomy, paediatrics are not just small adults! There are some significant anatomical differences with paediatric airways that are vital to understand - let's unpack them!
🧠 Head:
🧑⚕️ Large head relative to their body due to rapid brain development
🛏️ Large occiput causes neck flexion in the supine position - the “sniffing” position will cause the airway to “kink” resulting in obstruction
✅ Pro tip: The head should always be in a neutral position - sometimes you might need a towel/sheet under the shoulders to achieve this.
👃 Nose:
👶 Paeds < 6 months old are preferential nasal breathers due to the size of the tongue inhibiting oral breathing
🩹 Narrow nasal passages can be easily blocked by secretions resulting in obstruction
💨 Large adenoids can often cause airway obstruction
✅ Pro tip: Always have a range of paediatric Y-suckers within reach - kids are always snotty!
👄 Mouth:
👅 Relatively large tongue can easily cause airway obstruction
💔 Soft structures of the paediatric upper airway are easily prone to injury
🦷 Large tonsils can cause airway obstruction
✅ Pro tip: Paediatric guedel airways are inserted right way up (as opposed to upside down in adults) to prevent trauma to the palate.
🫁 Larynx:
🔼 Sits higher and more anterior - usually around the level of C3/4 (drops to C5 around adolescence)
🦠 The epiglottis is longer, floppy, and U-shaped - indirect manipulation with a MAC blade will likely yield a poor view
🧳 Trachea is shorter and funnel-shaped
🔴 Narrowest point of the trachea is at the level of the cricoid cartilage (vs vocal cords in adults)
✅ Pro tip: Have a range of cuffed and uncuffed (or microcuff) tubes available, as well as curved and straight blades! Only use a 3ml syringe for the cuff to prevent over inflation.
Build Knowledge ✅
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References:
Macfarlane, F. (2005). Paediatric anatomy and physiology and the basics of paediatric anaesthesia.https://resources.wfsahq.org/atotw/paediatric-anatomy-and-physiology-and-the-basics-of-paediatric-anaesthesia/
RCH (2024). Airway Management. https://www.rch.org.au/trauma-service/manual/airway-management/
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