INTRODUCTION Monitoring cardiac and respiratory function during helicopter transports can be difficult, so the authors devised a study of the esophageal stethoscope for pediatric patients. SETTING The study was conducted at Pediflite in Tennessee, which transports between 250 to 300 pediatric patients every year. MATERIALS AND METHODS A disposable esophageal stethoscope was used as an adjunct to other monitoring systems in intubated patients. Prior to transport, the stethoscope was placed orally by the respiratory therapist and advanced to the point where heart sounds are heard best, at which point breath sounds can also be heard clearly. The device's ear piece easily fit under the crew member's headphones, which block helicopter noise. Three sizes of stethoscope are available: a 6 French for patients 1 day to 4 years old, a 9 French for those 4 to 12 years old, and an 18 French for patients 12 years of age or older. RESULTS The esophageal stethoscope was used in 55 patients ranging in age from newborn to 18 years. Eighteen of 55 (33%) had multiple trauma or closed head injury, and 14 of 55 (25%) suffered respiratory failure. The esophageal stethoscope proved to be easy to place, had a low risk of complications and allowed continuous access to breath sounds. In addition, the ability to hear heart tones was minimally affected by noise or vibration. CONCLUSION Due to its ability to continuously monitor breath sounds, endotracheal tube obstruction or displacement can be rapidly detected by the esophageal stethoscope. Also, if there is failure of the cardiopulmonary monitor, heart sounds can be continuously monitored. The esophageal stethoscope is a simple but potentially valuable tool in pediatric and neonatal transports for monitoring respiratory and cardiac status.