The goal of this observesional study was to evaluate the improvement of the visual view of the larynx in neonates, infants and children with difficult airway using the Airtraq® Optical Laryngoscope, compared with visual views of the first conventional laryngoscopy with Macintosh blade. We studied clinical and/or laryngoscopic manifestations of difficult airway and advanced airway management of nine consecutive pediatric patients (2 neonates, 5 infants and 2 children) admitted from 1/1/2011 to 31/08/2012 for elective/emergency surgery or diagnostic procedure under general anesthesia. All nine pediatric patients had successful airway management and intubation, using the Airtraq® Optical Laryngoscope after intubation failure following conventional laryngoscopy. The percentage of glottis opening (POGO), the laryngoscopy difficulty level according to Cormack-Lehane Grade and the Visual Analogue Scale (VAS) of easiness in recognizing the laryngeal structures improved using of Airtraq® Optical Laryngoscope at 2nd attempt. Airtraq® Optical Laryngoscope could be a first-line device for intubation of neonates, infants and children with difficult airway.