Differences between the infant and adult airway

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

Print this page

This article have been viewed 11086 times

Differences between the infant and adult airway

Nicole W. Pelly, MD

The infant airway differs from the adult airway in structure and in functionality (Figure 192-1). Understanding these differences is important for airway management and, when necessary, for successful tracheal intubation of neonatal, infant, and pediatric airways.

Figure 192-1 Differences between the pediatric and adult airway. (By permission of Mayo Foundation for Medical Research and Education. All rights reserved.)

Anatomy

Head size

The head of an infant is proportionally larger than that of an adult because of the infant’s large occiput. Elevation of the head to produce an anatomic sniffing position in an infant or child is not needed. An infant or child with a large occiput can sometimes benefit from placing a small folded towel under the shoulders and neck, which slightly elevates the thorax. In addition, the head can be stabilized to prevent side-to-side movement.

Laryngeal position

The infant larynx is more cephalad than the adult larynx. At birth, the larynx is located opposite the first and second cervical vertebrae (C1 and C2), and the cricoid cartilage is opposite C3. This relationship provides a functional separation between breathing and swallowing so that the infant can suck, swallow, and breathe at the same time without aspirating. By the time a child is 2 years old, the larynx and cricoid have descended to C3-C4. The infant and pediatric larynx is in a more anterior position, and distances between the tongue, hyoid bone, epiglottis, and other oral structures are smaller than in an adult. In adults, the laryngeal opening is opposite the C5-C6 interspace, and the lower cricoid cartilage is located opposite the top of C7. The laryngeal position changes throughout childhood and, by age 8, is in the adult position.

Tongue

The infant tongue is proportionally larger than the adult tongue and is a common cause of airway obstruction. When infants or children are being mask ventilated, their airways are often enhanced by using an oral airway to relieve this obstruction.

Epiglottis

Buy Membership for Anesthesiology Category to continue reading. Learn more here

Related

Fausts Anesthesiology Review Expert Consult 4e