Pediatric Airway Complications: Causes and Solutions

Pediatric airway problems can lead to devastation for families. According to the  Pediatric Perioperative Cardiac Arrest (POCA) registry, respiratory events led to 27% of all pediatric perioperative cardiac arrests.

Likely, this is the first traumatic event the child has experienced and causing further distress will only increase the severity of the problem. It falls to responders to keep an open and friendly disposition during these events, making medical care less intimidating. To be able to focus on that type of demeanor, prior education and comprehension of the causes and solutions to these complications is vital to potentially saving a child’s life or preventing long-term harm.

Pediatric Anatomy

Children are naturally at a higher risk of airway obstructions and complications because of the anatomy of their respiratory system, which is still developing in the early stages of life and weaker than an adult’s system. The younger the child, the more tenuous the situation — infants, for example, are at a higher risk for airway emergencies than toddlers. Beyond age, other factors can play a role, too, such as if a child genetically has larger than average tonsils. That can cause an increased risk for airway obstruction.

Other important points:

• Newborns and infants are typically obligate nose breathers, so don’t forget to suction the nasal passageways when treating the very young.

• The tongues of infants and children up to two years of age are disproportionately larger than those of adults and rest entirely within the oral cavity, posing not only a danger for obstruction, but requiring care during suctioning so as not to force them back into the oropharynx.

• Be careful when positioning the infant or child’s head for suctioning, since their larger skulls and shorter necks can produce crimping of the airway when they are placed in the supine position. Always pad the shoulders during treatment when trauma is not suspected.

• Children are also predisposed to pediatric airway problems due to having immature nervous systems, with such complications as an underdeveloped respiratory center and parasympathetic tone, an immature brain, and behavioral responses that differ from an adult’s.

Hypoxia Among Infants and Small Children

Many of the limitations from a child’s anatomy, when combined with a condition affecting their respiration, can lead to hypoxia, or low levels of oxygen in their body tissues. It is imperative that the symptoms of hypoxia be recognized right away, as it can create a life-threatening situation. Cleveland Clinic describes the symptoms as:

• Restlessness
• Headaches
• Confusion
• Anxiety
• Rapid heart rate and breathing
• Extreme restlessness

Also be on the lookout for bradycardia, a condition in which the heart beats less than 60 beats per minute. Although bradycardia is most common amongst adults, in children, the condition may be the first sign of hypoxia.

A key factor in mitigating the risk of hypoxia during airway management is timing. Prolonged suctioning will cause hypoxia quicker than in adult patients, so limit suctioning to under 10 seconds.

Knowledge and Preparation Save Lives

Responders must recognize that infants and toddlers have different needs than adults when it comes to addressing airway problems.

For example, when opening the pediatric airway, the size and age of the child must be considered. Finding the correct airway device tip makes a significant difference, as children require smaller tips, and a soft French tip is ideal for infants and neonates, because their tissues are more delicate. Those tissues also require providers to use less pressure when using a portable suctioning device.

The balance in providing effective — and swift — airway treatment with gentle care is difficult, but it’s a worthy goal that can save our most vulnerable and precious patients.