Neck: Ask about foramen magnum decompression, shunts and sleep studies; keep the neck neutral and avoid hyperextension or forced flexion
Positioning: Support the head and short limbs with pillows; a booster or positioning aids help in an adult-sized chair
Sedation risk: obstructive sleep apnea (OSA), midface hypoplasia and possible cervical stenosis. Coordinate the setting, airway and postoperative monitoring with anesthesia. Significant OSA, neurologic compromise, or a difficult airway may require a hospital with pediatric expertise
Occlusion: Orthodontic referral for Class III and crowding; coordinate with craniofacial care and the child’s growth pattern
Communication: normal cognition; talk to the child at their age, not their height