Infants often require endotracheal intubation to provide adequate ventilation during anaesthesia to cover diagnostic or therapeutic procedures such as MRI scans or surgery in case of congenital or acquired conditions. At the Evelina London Children’s Hospital alone, we anaesthetise and intubate over 1,200 infants every year.  The lack of ventilation, with absence of oxygen supply to the body and the resulting anoxic brain injury, is a catastrophic complication of anaesthetic management leading to important morbidity and mortality.1, 2 It is also associated with a heavy emotional burden for anaesthetists and financial costs for Trusts.3 Infants are particularly vulnerable given their limited pulmonary reserve, anatomically complex airway and rapid swelling after manipulation compromising further the airway. Rescue procedures are more difficult. Stratifying this airway risk and providing guidance on how to manage airways is key to improving outcomes, particularly in ethnic minority groups that are known to face more perioperative airway events.4  Recent Difficult Airway Society guidelines in adults,5 have reported the importance of videolaryngoscopy (VL) to improve airway management and successful endotracheal intubation at the first attempt, however there are sparse clinical data to validate it as the first line airway management. The paediatric difficult airway guidelines6 also advocate for the use of VL versus direct laryngosocopy (DL), without data to support it. Results of international trials indicating the superiority of videolaryngoscopies over direct laryngoscopies rely on the use of neuromuscular blocking agents and intubation stylets which are far from the current British practice.7, 8  Both DL and VL are acceptable practice in paediatric anaesthesia and used daily interchangeably by anaesthetists. VL is gaining momentum in the adult community but still rarely used by paediatric anaesthetists, despite its potential.9  Possible advantages of videolaryngoscopy in infants include:10  • a visualisation of the airway by the anaesthetic assistant or colleagues to support the anaesthetist managing the airway in case of difficulties allowing a shared mental model. • a better visualisation of the oropharynx and larynx, especially if mouth opening or neck mobility range are limited, or in case of congenital syndrome such as a Pierre Robin sequence or achondroplasia making the approach of the trachea harder. • better adjustment of endotracheal tube positioning and cuff inflation to seal the lower airway. There are no clear disadvantages of VL except its cost, requiring remote monitor screen and expensive disposable blades compared to DL.  Videolaryngoscopy has become the first approach in some adult centres, based on daily clinical practice rather than clear results and robust data collected in randomised trials. In children and particularly in infants, the community relies more heavily on study data to promote change of practice. Recent guidelines both in adults and children are suggesting that VL should play a wider role. As both DL and VL modalities are perfectly acceptable as first line management of the infant airway, we propose a controlled randomised trial assessing them.