This chapter describes guidelines for difficult pediatric airway management. A difficult airway is defined as a situation in which a conventionally trained anesthesiologist experiences difficulty with face mask ventilation, laryngoscopy, or intubation. In an emergency setting, this also includes difficulty performing an emergency surgical airway, like needle cricothyroidotomy. This chapter covers the difficult pediatric airway, assessment and identification, preparation of airway management, airway management plan, and alternative approach for difficult airway. Effective airway management includes anticipating and planning. Difficulties frequently occur as the result of patient characteristics that interfere with spontaneous breathing, bag mask ventilation, laryngoscopy, and/ or intubation of the trachea.