Airway management is an important aspect of pediatric emergency care. Prompt, effective airway access can mean the difference between a good outcome and disability or death. Optimal management requires an understanding of the differences between children and adults with respect to airway anatomy and physiology and response to medications to facilitate airway access. In most cases, the emergency physician is called to secure a child's airway with little forewarning. This review details a logical and practical approach to the uncomplicated pediatric airway. Emphasis is also placed on recognition of the difficult airway and methods to render the difficulty less daunting. Good judgment and the appropriate skills are the prerequisites for success.