A wide spectrum of pediatric diseases present challenging airway problems for the anesthesiologist. To optimize the management of the difficult airway, an understanding of the pediatric airway anatomy, its peculiarities in certain diseases and the syndromes which compromise the airway is imperative. Many cases of the difficult airway are easily recognizable, while others are obscure and turn obvious only during anesthesia. The pediatric airway is always physiologically disadvantaged than the adult. There is increased oxygen consumption with less oxygen reserve. Gastric distention is an expected occurrence with mask ventilation, causing elevation of the diaphragm, reduction of functional residual capacity (FRC) and oxygen reserve, decreased lung compliance, interference with positive pressure ventilation, and increased risk of regurgitation and aspiration. Even general endotracheal anesthesia significantly decreases FRC in infants. Upper airway obstruction during general anesthesia is common because of increased sensitivity of certain inspiratory muscles to anesthetic agents. Failure to maintain a patent airway can readily result in morbidity and mortality.