OBJECTIVE: To evaluate the intubating laryngeal airway (ILA) in providing safe endotracheal intubation in pediatric patients with difficult airway; to describe a method for using flexible fiberoptic bronchoscopy with the ILA for evaluating the pediatric airway. METHODS: Case series with chart review of the medical records of patients who had the ILA and fiberoptic intubation used to secure the airway at a tertiary pediatric hospital from January 2009 to January 2011. We documented the circumstances necessitating airway management, ILA success, airway evaluation findings, and medical conditions contributing to difficult airway. RESULTS: Fifty patients met criteria for review. The median age was 59.8 months (0.3-244.1), and the median weight was 19.0kg (2.6-86). Four cases (8%) were unanticipated difficult airways and 46 (92%) were anticipated difficult airways. Nine (18%) of the 50 procedures were performed emergently. Comorbid conditions included craniofacial syndromes (n=36), cervical spine instability/immobility (n=9), and airway hemorrhage (n=3). 48 (96%) patients were fiberoptically intubated on first attempt through the ILA. In 2 patients, fiberoptic intubation required a second attempt. The overall success rate using the ILA and fiberoptic intubation to secure the airway was 100%. CONCLUSION: ILA and fiberoptic-guided tracheal intubation is a safe and effective method for securing the airway in pediatric patients with difficult airway and can be a useful alternative to direct laryngoscopy when laryngeal exposure is suboptimal.