Pediatric airway management is one of the most stressful and fearful activities within the emergency department. We use these skills less often as compared with adults, and therefore the familiarity, mental and muscle memory are not as tuned. There is also a tremendous cognitive load during pediatric resuscitations determining the appropriate sized equipment and medication dosing, increasing the pressure.

There are numerous critical differences in managing the pediatric airway. There are anatomical differences, especially in children <2-years of age. The child’s head is much larger in proportion to their body than adults, with a large occiput which often requires position of padding behind the shoulders. The airway is also very anterior to what you are used to in adults. Given the small size of the airway, they tend to obstruct much easier, and the stimulation and pain of a resuscitation can lead to dynamic obstruction. There are physiologic differences. Child have a much higher base line oxygen consumption rate than adults and small proportional functional reserve capacity (FRC) which leads to quicker desaturations. Lastly, all medications require weight-based dosing.

While BVM ventilation, direct/video laryngoscopy (including the speciality pediatric blades) are foundation of managing the pediatric airway, the primary backup airway adjunct are the supraglottic devices. In some situations they may be useful for primary BVM ventilation.

Supraglottic airways (ie SGA, Laryngeal Mask Airway, LMA) are available in non-intubating and intubating pediatric sizes. They are sized by patient weight (which is on the device packaging) from newborn to adolescent. The reason