But there are other factors, too. For example, in infants, the back of
the skull is larger in relation to the body, which flexes the neck in the
supine position, causing them to assume a "sniffing" position. Children
also have a relatively narrow and short epiglottis that's angled into the
lumen of the airway and is often difficult to displace during laryn-
goscopy. Understanding the challenges and your options can help you
breathe easier when small patients depend on your skills and expertise.
Let's review our options.
Mask ventilation
These days, I only use mask ventilation for short cases, such as when
ENT docs put in ear tubes, and only because the procedure is so
short. It's usually easy in children 4 years and older who have normal
facial anatomy. Hold
the mask over the
mouth and nose with
the thumb and fore-
finger, with the mid-
dle finger on the bony
portion of the
mandible. The middle
finger lifts the chin to
extend the head with-
out compressing the
neck. One caution: Be
sure to rest the upper
part of the mask on
the bridge of the
nose. Inexperienced
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