The physical examination for airway assessment focuses on identifying anatomical factors that may predict difficulty with airway management. Key aspects include evaluating the symmetry of the head, face, and neck, assessing mouth opening, checking for oral pathology, and measuring both the mentohyoid and thyromental distances. The Mallampati score, a common predictor of intubation difficulty in adults, can also be applied to cooperative children. However, since children may not always fully cooperate during an oral exam, an abnormal Mallampati score in an otherwise normal child may not reliably indicate a difficult airway.
Not all predictors of difficult airways in adults apply to pediatric patients. For example, factors like neck circumference and body mass index, which are relevant in adults, have not been validated as independent risk factors in children. However, features like limited head extension, reduced mandibular space, and increased tongue thickness are reliable predictors of difficult intubation in pediatric populations.
