UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric Laryngoscope Blade Size Selection Using Facial Landmarks

Keywords: Pediatric Laryngoscope blade size, RSI, Airway Management, Intubation (PubMed Search)

Posted: 5/31/2008 by Don Van Wie, DO (Updated: 4/22/2024)
Click here to contact Don Van Wie, DO

Remember in the heat and pressure of a pediatric intubation (if you don't have your Pediatic Qwic Card handy) you can estimate what size blade to use very quickly and successfully by using facial landmarks!!

  • Distance from the upper incisor teeth to the angle of the jaw seems to be an excellent clinical landmark for laryngoscope blade length selection for pediatric intubations under 8 years of age 
  • Take the blade (excluding the handle insertion block) and place at the upper midline incisor teeth and if the tip is located within 1 cm proximal or distal to the angle of the mandible, oral tracheal intubations are more consistently accomplished on the first attempt!!!     90% on first attempt with correct size blade v. 57% on first attempt if blade too short

And remember to start with a straight blade (Miller, Wisconsin, Guedel, Wis-Hipple etc.) for your patients under 2 years of age because:

  • these blades make controlling the tounge and epiglottis easier than curved blades at this age
  • and they have a smaller flange profile in the oropharynx so visualization of the vocal cords is clearer


Pediatric Emergency Care. 22(4):226-229, April 2006.
Mellick, Larry B. MS, MD, FAAP, FACEP ; Edholm, Thomas MD, FACEP ; Corbett, Stephen W. MD, PhD, FACEP