The key idea is that securing a airway and preparing for intubation in infants and children who are at risk for respiratory failure requires specialized pediatric airway experience. Pediatric airways are very different from adults: they’re smaller and more easily obstructed, with unique anatomy and physiologic responses. A clinician with substantial pediatric expertise is best equipped to anticipate difficulties, choose the correct endotracheal tube size, select appropriate ventilation settings, and manage potential complications such as rapid desaturation, bradycardia, or hemodynamic instability during intubation. This expertise also supports rapid decision-making about when preoxygenation, sedation, or neuromuscular blockade is appropriate, and how to optimize the airway plan for a child with a potentially difficult airway. While nurses, general physicians, and paramedics play critical roles in resuscitation and can assist, the act of ventilation and preparing for a secure airway in a high-risk pediatric patient benefits from leadership by someone with deep pediatric airway experience. This ensures the team uses pediatric-specific equipment, techniques, and crash-cart readiness, reducing risk and improving outcomes for these vulnerable patients.