Editing Tracheal intubation (section)

===Children===
[[File:Premature infant with ventilator.jpg|thumb|alt=A premature infant, intubated and requiring mechanical ventilation|A [[Preterm birth|premature infant]] weighing {{convert|990|g|oz|abbr=off}}, intubated and requiring [[mechanical ventilation]] in the [[neonatal intensive-care unit]]]]

There are significant differences in airway anatomy and respiratory physiology between children and adults, and these are taken into careful consideration before performing tracheal intubation of any [[pediatrics|pediatric]] patient. The differences, which are quite significant in infants, gradually disappear as the human body approaches a mature age and [[body mass index]].<ref name=Cravero2009/>

For infants and young children, orotracheal intubation is easier than the nasotracheal route. Nasotracheal intubation carries a risk of dislodgement of [[pharyngeal tonsil|adenoids]] and nasal bleeding. Despite the greater difficulty, nasotracheal intubation route is preferable to orotracheal intubation in children undergoing intensive care and requiring prolonged intubation because this route allows a more secure fixation of the tube. As with adults, there are a number of devices specially designed for assistance with difficult tracheal intubation in children.<ref name=Borland1990/><ref name=Theroux1995/><ref name=Kim2008/><ref name=Hackell2009/> Confirmation of proper position of the tracheal tube is accomplished as with adult patients.<ref name=Rabb2007/>

Because the airway of a child is narrow, a small amount of glottic or tracheal [[edema|swelling]] can produce critical obstruction. Inserting a tube that is too large relative to the diameter of the trachea can cause swelling. Conversely, inserting a tube that is too small can result in inability to achieve effective positive pressure ventilation due to retrograde escape of gas through the glottis and out the mouth and nose (often referred to as a "leak" around the tube). An excessive leak can usually be corrected by inserting a larger tube or a cuffed tube.<ref name=Sheridan2006/>

The tip of a correctly positioned tracheal tube will be in the mid-trachea, between the [[clavicle|collarbones]] on an [[Anteroposterior#Anterior and posterior|anteroposterior]] chest radiograph. The correct diameter of the tube is that which results in a small leak at a pressure of about {{convert|25|cm|0|abbr=on}} of water. The appropriate inner diameter for the endotracheal tube is estimated to be roughly the same diameter as the child's little finger. The appropriate length for the endotracheal tube can be estimated by doubling the distance from the corner of the child's mouth to the [[ear canal]]. For [[Preterm birth|premature infants]] {{convert|2.5|mm|in|sigfig=1|abbr=on}} internal diameter is an appropriate size for the tracheal tube. For infants of normal [[Gestational age (obstetrics)|gestational age]], {{convert|3|mm|in|sigfig=2|abbr=on}} internal diameter is an appropriate size. For normally nourished children 1&nbsp;year of age and older, two formulae are used to estimate the appropriate diameter and depth for tracheal intubation. The internal diameter of the tube in mm is (patient's age in years + 16) / 4, while the appropriate depth of insertion in cm is 12 + (patient's age in years / 2).<ref name=Rosenblatt2009/>