Oropharyngeal Airways in Paediatric Patients

Oropharyngeal airways (OPAs) are useful in maintaining airway patency in unconscious patients of all ages. OPAs are often referred to as a Guedel's airways, after the American physician who developed them. These devices are useful adjuncts in unconscious patients, but do carry risks if not sized or inserted correctly.

General paediatric airway considerations:

• Appropriate sizing requires access to the full range of OPA sizes to ensure the correct one is used based on the anatomical structures of the child or infant.  
• Prior to insertion remove visible debris from the oropharynx via suction, avoid extended periods of suctioning to minimise the risk of bradycardia.  
• Do not perform blind finger sweeps in children, as this can force a foreign body further down the airway and completely occlude at the level of the cricoid ring. 
• Be aware of loose dentition, as school aged children may have loose teeth that can become dislodged in the airway. 

When inserting an OPA in children under 8-years-old:

• Sizing is important: measure from the centre of the incisors to the angle of the mandible
• Use a tongue depressor to assist in insertion: in paediatrics this is needed to ensure the tongue is not pushed back by the oropharyngeal airway 
• Insert the oropharyngeal airway gently: insert under direct vision, putting the oropharyngeal airway in concave side down. This is to avoid damaging the soft palate.
• Continue to use jaw thrust after insertion, to maximise airway patency
• Hold the head in the appropriate position for the age of the patient: neutral position for infants under 12 months of age, and the slight sniffing position for children aged over 1 year 

If you are interested in updating your knowledge and confidence in paediatric airway management, you may be interested in attending our Paediatric Advanced Life Support courses These workshops utilise a simulation based approach and are based upon the current Australian Resuscitation Council guidelines. 

• Paediatric Advanced Life Support
• Paediatric Airway Emergencies

For a full list of events and courses please visit https://medcast.com.au/courses. 

References:

Australian and New Zealand Council on Resuscitation (ANZCOR)  ANZCOR Guideline 12.6 – Introduction to Paediatric Advanced Life Support Techniques in Paediatric Advanced Life Support. 

Hambrecht, K. (2019). Cardiopulmonary resuscitation: basic and advanced life support.  Chapter 70 in Brown, D., Edwards, H., Buckley, T., and Aitken, R.L. (eds.). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. (5th edn.). Elsevier: Chatswood.

Royal Children’s Hospital Melbourne (RCH) 2019, The Paediatric Trauma Manual: Airway Procedures.

Content reviewed 2/2025