Anatomical Differences
Children have a larger tongue relative to the mouth, a more anterior and superior larynx, a floppy epiglottis, and a narrower trachea. A small amount of swelling or secretions can cause significant obstruction. The occiput is large, so flexion of the neck can occur when lying supine.
Positioning
Place a small pad under the shoulders of a young child to keep the airway in a neutral or slightly sniffing position. Do not hyperextend the neck, because the trachea can kink. Infants are obligate nose breathers, so clearing the nostrils with a bulb syringe can make a major difference.
Ventilation Rates
For a child or infant with a pulse who needs ventilation, give about 1 breath every 2 to 3 seconds (20 to 30 breaths per minute). Use smaller volumes, just enough to see chest rise. Bradycardia in a child is most often caused by hypoxia, so airway and oxygenation come first.