In pediatric patients, which statement about the airway is true?

• A. The tongue is relatively smaller.
• B. The ribs and cartilage are stiff and nonpliable.
• C. Children rely on their intercostal muscles for breathing.
• D. The cricoid cartilage is the narrowest part of the airway.

Answer: (D)

In children the airway is most restricted at the cricoid cartilage, which forms a narrow ring just below the larynx. Because this is the smallest fixed diameter in the pediatric airway, even minor swelling or secretions can markedly reduce airflow and it guides how we size and place an endotracheal tube. In contrast, the tongue in infants is relatively large and can cause obstruction, not smaller; the chest wall and cartilage are more pliable rather than stiff; and intercostal muscles are less developed, so children rely more on the diaphragm for breathing. Thus, the statement that the cricoid cartilage is the narrowest part of the airway is the true one.