Remember in the heat and pressure of a pediatric intubation (if you don't have your Pediatic Qwic Card handy) you can estimate what size blade to use very quickly and successfully by using facial landmarks!!
Distance from the upper incisor teeth to the angle of the jaw seems to be an excellent clinical landmark for laryngoscope blade length selection for pediatric intubations under 8 years of age
Take the blade (excluding the handle insertion block) and place at the upper midline incisor teeth and if the tip is located within 1 cm proximal or distal to the angle of the mandible, oral tracheal intubations are more consistently accomplished on the first attempt!!! 90% on first attempt with correct size blade v. 57% on first attempt if blade too short
And remember to start with a straight blade (Miller, Wisconsin, Guedel, Wis-Hipple etc.) for your patients under 2 years of age because:
these blades make controlling the tounge and epiglottis easier than curved blades at this age
and they have a smaller flange profile in the oropharynx so visualization of the vocal cords is clearer
References
Pediatric Emergency Care. 22(4):226-229, April 2006. Mellick, Larry B. MS, MD, FAAP, FACEP ; Edholm, Thomas MD, FACEP ; Corbett, Stephen W. MD, PhD, FACEP
