Paediatric airway compromise is a life-threatening emergency that requires rapid recognition and prompt management. Children are at higher risk of airway obstruction compared to adults due to anatomical and physiological differences. Their airways are smaller in diameter, the tongue is relatively larger, the epiglottis is floppier, and the larynx is positioned more anteriorly and superiorly. Even minimal swelling, secretions, or foreign bodies can significantly reduce airflow.
Common causes of paediatric airway compromise include infections, allergic reactions, trauma, and foreign body aspiration. Infectious causes such as croup, epiglottitis, and bronchiolitis can lead to inflammation and narrowing of the airway. Anaphylaxis causes rapid airway edema and bronchospasm. Trauma to the face or neck may result in bleeding or swelling, obstructing airflow. Foreign body aspiration is particularly common in toddlers and can cause sudden onset choking, coughing, or cyanosis.
Clinical features depend on the severity and location of obstruction. Early signs include tachypnea, nasal flaring, use of accessory muscles, and stridor (a high-pitched sound during inspiration). As obstruction worsens, children may develop hypoxia, altered consciousness, bradycardia, and eventually respiratory arrest. Silent chest or decreased air entry is a late and dangerous sign.
Management follows the ABC (Airway, Breathing, Circulation) approach. Immediate assessment and oxygen administration are crucial. Positioning the child comfortably, often upright, helps maintain airway patency. In mild cases, medical treatment such as nebulized adrenaline or corticosteroids may reduce inflammation. Severe obstruction may require advanced airway management, including bag-mask ventilation or endotracheal intubation. In rare cases, emergency surgical airway procedures such as cricothyrotomy may be necessary.
Early recognition, calm handling of the child, and timely intervention are essential to prevent morbidity and mortality. Proper training of healthcare providers and caregivers plays a vital role in improving outcomes in paediatric airway emergencies.