The technique can be very helpful and life-saving if you are faced with a child with facial or oral deformities that interfere with the ability to insert a laryngoscope or to see the larynx.

Example: Such problems can arise with severe Pierre Robin sequence (cleft palate with severe micrognathia).

Practical Steps:

Digital Intubation

• Insert the index finger of the left hand into the baby’s mouth, with it’s palmer surface sliding along the tongue. Use the little finger if the baby is small.

• Slide the finger along the tongue until it meets the epiglottis. This feels like a small band running across the root of the tongue.

• Slide the finger a little further until the tip lies behind and superior to the larynx and the nail touches the posterior pharyngeal wall.

• Slide the tube into the mouth between the finger and the tongue until the tip lies in the midline at the root of the distal phalanx of the finger.

• At this point place the left thumb on the baby’s neck just below the cricoid cartilage in order to grasp the larynx between the thumb on the outside and the fingertip on the inside.

• While the thumb and finger steady the larynx against side to side motion, the right hand advances the tube 1-2 cm.

• A slight give can sometimes be felt as the tube passes into the larynx but no force is needed for insertion.

• When the tube is in the trachea the laryngeal cartilages can be felt to encircle it. If it has passed into the oesophagus it can be felt between the finger and the larynx.

* It is worth practising this technique on a stillborn baby; only then can you appreciate how easy it is.

* This system was regularly practiced in New Orleans for more than 20 years from the early 1940’s. Skilled practitioners were said to be able to place a tube in a baby with normal anatomy in 3 to 5 seconds using this technique.