The induction of anesthesia in patients who are at risk for pulmonal aspiration is a challenge for the anesthetist. The anesthesiological management of adult patients includes strategies to avoid pulmonal aspiration in addition to a rapid, competent protection of the airway without the danger of hypoxia. The well established Rapid Sequence Induction (RSI) in adults cannot be transmitted to children for some reasons. Furthermore many anesthetists are confronted with the problem, that children are infrequent patients in their clinical everyday life, with the lack of routine bustle and nervousness find their way in these situations, which can lead to further complications. Consistent recommendations concerning the anesthesiological management of children at risk for pulmonal aspiration do not yet exist. The "Wissenschaftlicher Arbeitskreis Kinderanästhesie" of the "Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin" has elaborated recommendations based on scientific investigations, systemic literature review and clinical experience of experts. According to these recommendations, the anesthesiological management of children at risk for pulmonal aspiration will be reviewed in the following, in order to simplify the implementation of individual institutional algorithms.