Airway problems remain a leading cause of perioperative morbidity and mortality in children. Proficiency and expertise in airway management are, therefore, key elements for the safe conduct of anaesthesia in children. Clear strategies must be in place to successfully manage children with a normal, acutely impaired and expected difficult airway. Simple, forward only, easy to memorize and practice algorithms are essential in daily practice in preparation for the unexpected difficult paediatric airway. The child with the acutely impaired normal airway and known difficult airway is the domain of the experienced anaesthesiologist in an appropriately staffed and equipped paediatric setting. The following review describes current concepts and developments in the management of the difficult paediatric airway.