Ventilation with small diameter tubes presents considerable problems to the anaesthesiologist, particularly in paediatric patients with narrowed airways. Clinical situations such as the “cannot intubate, cannot oxygenate” (CICO) scenario or ventilating a stenosed or oedematous airways have always been managed with traditional small-bore airway ventilation, including manual jet ventilation (Manu-jet) or the classical three-way stopcock. Those techniques were effective in providing temporary oxygenation but exposed the patient to serious complications such as barotrauma, air trapping with auto-PEEP, severe hypercapnia and acidosis. Ventilation systems have evolved significantly in recent years. The notion of manually managing both inspiratory and expiratory flow has been used to improve ventilation of the small-calibre airway while avoiding the issues associated with previous approaches. As a result, the Ventrain®, or Flow-Controlled manual Ventilator (FCmV), was developed with the goal of providing “Expiratory Ventilation Assistance” (EVA) by jet-flow suction to aid in active expiration, as well as manually controlling the inspiratory flow, which regulates the volume of inhaled gas per second. These characteristics have demonstrated that the Flow-Controlled manual Ventilator (FCmV) is a safer means of breathing for young patients with restricted airways. Another advancement in the ventilation of the narrow caliber airway was the invention of the “Flow-Controlled automatic Ventilator”, such as the Evone®. It allows for ventilation through narrow cuffed tubes like the Tritube® (<3 mm), extending ventilation time. However, this novel technique is still of limited use in children weighing less than 40 kg pending validation. Problems in ventilating children with airway narrowing, CICO scenarios in children, and shared airway surgeries are being addressed with ultra-new modalities. This chapter discusses the pathologies of the paediatric airway and the relative application of those innovations.