Airway and breathing compromise are among the most critical challenges faced by primary care providers (PCPs) in the initial management of pediatric trauma, especially in resource-limited and prehospital environments. Anatomical and physiological differences in children—such as narrower airways, larger tongues, and higher oxygen demand—contribute to rapid deterioration following trauma. This chapter aims to equip PCPs with a structured, high-yield approach to recognizing and managing airway and breathing emergencies in injured children. Using the ABCDE framework, readers are guided through rapid assessment; identification of red flags such as stridor, gurgling, hoarseness, and altered mental status; and the application of timely, lifesaving interventions including suctioning, airway adjuncts, oxygen therapy, and assisted ventilation. The case scenario of a young boy injured in a remote hill dispensary highlights real-world decision-making under pressure, emphasizing the importance of teamwork, role clarity, and clinical vigilance when pediatric expertise is not immediately accessible. Reflective questions explore the application of the Pediatric Assessment Triangle (PAT), airway triage roles, and referral communication essentials. Practical sections on airway examination, signs of obstruction, and ventilation management highlight the need for readiness and adaptability. This chapter empowers PCPs to confidently identify, manage, and stabilize airway and breathing threats in pediatric trauma—buying crucial time until definitive care can be provided and improving survival in the golden hour.