When inserting an oropharyngeal airway in a child, you should:

• A. Insert before opening the mouth
• B. Insert with the curved end facing the hard palate
• C. Oropharyngeal airway is contraindicated in children
• D. Use a tongue blade to depress the tongue

Answer: (D)

The essential idea is that the tongue is a major cause of airway obstruction in children, especially when the child is unconscious. An oropharyngeal airway can keep the tongue from falling back and blocking the airway, but you must create a clear path for it first. Depressing the tongue with a tongue blade moves the tongue forward, opening the oropharynx so the airway can sit properly in place and keep the airway open. This step directly addresses why the device would work in a pediatric patient by preventing ongoing obstruction from the tongue itself.

Open the mouth and depress the tongue before inserting the airway so you don’t push the tongue into the airway or trap it behind the device. The other ideas either describe steps that aren’t as reliable in guaranteeing a patent airway or rely on a technique that isn’t the priority in this scenario. In a child who is unconscious and lacks a protective gag reflex, this tongue-depression step makes the placement and effectiveness of the airway most likely to succeed.