How do you align the airway of a child during resuscitation?

• A. One-inch pads under the shoulders
• B. Head-tilt-chin-lift without pads
• C. Place in a prone position
• D. Use a blanket roll under the back

Answer: (A)

During resuscitation, the airway is best aligned by positioning the child so the head is in a neutral to slightly extended position without overextending the neck. Placing a small pad under the shoulders achieves this by elevating the upper body just enough to align the oral, pharyngeal, and laryngeal axes with the trachea. In children, the head is relatively large compared to the body, so without that elevation the occiput tends to tilt the head back excessively or the airway can collapse, making ventilation harder. A one-inch pad under the shoulders provides the correct amount of tilt for effective bag–valve–mask ventilation and easier airway management. Placing the head with a full head-tilt without pads can overextend the neck or worsen alignment; placing the child prone or rolling a blanket under the back disrupts airway alignment and hinders ventilation and chest compressions, so those options are not appropriate during resuscitation.