Most infants and children who lose their spontaneously ability to breathe can
have their breathing augmented by bag mask ventilation (BVM). Any obstruction
(including salivary secretions, vomitus or foreign material) should be recognized.
The tongue can also be obstructive especially when the child is sedated or non-
responsive. A “jaw thrust” or a “sniffing” position creates the optimal alignment for
BVM. Peripheral oxygen saturation should be monitored to assure the success of
BVM. It is easy to distend the child’s stomach during this maneuver. Gastric
distention can lead to bradycardia, and so it should be rectified..
When considering intubation, one should examine the airway carefully. This
assessment should start with an external examination. In an awake child (e.g.,
prior to an elective intubation for a surgical procedure), this includes a mouth
opening assessment to see whether the pharynx can be seen (Mallampati exam),
measurement of hyomental distance (at least three fingerbreadths) and thyrohyoid
distance (at least two fingerbreadths), and relative neck mobility.
When preparing to intubate, the child should be preoxygenated with a bag
mask and ventilated with 100% oxygen. The HR and saturation should be
monitored continuously. The suction, ETT, laryngoscope should be readily
available. When needed, the SellIck maneuver (which refers to the gentle pressure
on the cricoid cartilage to avoid aspiration of gastric contents) should be performed
before the administration of induction agent which consists of sedative and a rapid
acting neuromuscular blockade agent. NOTE: WHEN A PATIENT HAS A