Airway Anatomy Upper Airway Problems in Infants

There is perhaps nothing more terrifying to new parents than breathing problems in an infant. Particularly among newborns, respiratory distress is a common and potentially life-threatening symptom. Key differences in the airways of infants and children make them more susceptible to certain respiratory problems. A keen understanding of upper airway anatomy can help you quickly and safely treat infants in respiratory distress.


Airway Anatomy Basics

At first glance, an infant’s airway looks identical to that of an adult. But looks can be deceiving. Infants’ airways are proportionally narrower, which increases the risk of respiratory obstruction. The airway is also shorter, with a proportionally larger tongue that can make intubation more challenging.


Infants and young children have a larynx that is placed more anteriorly compared to an adult. The epiglottis is also longer and narrower. For children under 10, the narrowest portion of the airway is at the cricoid cartilage below the glottis. 


Perhaps most critically, newborns are nose breathers until age two to six months—and longer if they are born prematurely. This makes minor upper respiratory infections more dangerous because newborns may not automatically open their mouths to breathe if the nose is blocked.


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Common Respiratory Problems

Because of the slight differences in respiratory anatomy, infants tend to have difficult-to-manage airways. Understanding the most common respiratory issues infants face can help first responders offer more effective treatment while reducing the risk of iatrogenic injuries. Some common respiratory issues in babies include:


  • Congenital issues, particularly in premature newborns. Aspiration of meconium is a common medical emergency in newborns. At least 7% of neonates experience respiratory distress shortly after birth.

  • Apnea, irregular breathing, and shallow breathing.

  • Choking, especially caused by swallowing small objects.

  • Aspiration, especially in premature infants, infants who are vomiting, or infants with upper respiratory infections.

  • Respiratory infections such as RSV, cold, flu, and pneumonia.

The distinct anatomy of infants means that symptoms of respiratory distress are often slightly different in this vulnerable group. Some signs of infant respiratory distress include:


  • Retractions

  • Nostril flaring, especially when accompanied by loud breathing.

  • Blue or white color. This may be subtle, affecting only the lips, tongue, or nail beds.

  • Rapid pulse.

  • Sleepiness or feeding difficulties.

First responders must err on the side of caution when infants have airway issues. A delayed response can cause lasting damage to the baby’s brain, respiratory system, or organs.


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 Airway Anatomy and the Right Respiratory Equipment

The airway equipment your team uses with adults is not the right equipment for babies. Infants need smaller catheters before intubation and suctioning. Moreover, their delicate airways are more vulnerable to airway trauma. It’s important to choose the right airway management equipment and ensure you have appropriate attachments and disposables available.


Equally important is ensuring you can easily tend to a baby in respiratory distress. Transporting an ill infant is not always easy. A portable emergency suction machine allows you to tend to the patient faster, administering care wherever they are without the risks or delay of moving them to an ambulance. To ensure prompt and high-quality care, store infant-appropriate respiratory equipment in a separate bag and place that equipment with your portable emergency suction machine.


The ideal suction device can quickly clear infants’ airways, potentially saving their lives. The right device is a versatile and portable one, allowing you to care for people of all ages, including even the smallest newborns.


Editor's Note: This blog was originally published in February, 2019. It has been re-published with additional up to date content.

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