The anaesthetic management of children with craniofacial abnormalities often presents unique challenges because soft tissue and bony abnormalities can affect the airway and influence airway management. We report four paediatric patients with predicted difficult airways due to craniofacial abnormalities. They all had a laryngeal view of Cormack-Lehane grade IV and were impossible to intubate using direct laryngoscopy. Fibreoptic intubation was also repeatedly attempted but was not successful. All the tracheal intubations were completed using a lightwand on the first attempt in less than 30 s. We consider that lightwand guided intubation technique may be a useful alternative approach to fibreoptic intubation technique in managing the difficult paediatric airway.