The goal of this literature review is to provide the anesthesia practitioner with the skill set to detect and prepare for a difficult pediatric airway. The authors have reviewed and compiled information on some of the most common conditions that can predispose pediatric patients to a difficulty airway, such as macroglossia, mandibular hypoplasia, micrognathia, cervical instability, limited cervical movement, maxillary and midfacial hypoplasia, and cleft palate. This article provides an overview of preoperative assessment techniques, normal pediatric airway anatomy, and respiratory physiology. An emphasis is placed on some common syndromes and their related anatomical abnormalities that can compromise the airway, as well as anesthetic approaches recommended to successfully secure a potentially difficult airway.