Epiglottitis in Children

What is epiglottitis in children?

The epiglottis is a flap of cartilage at the base of the tongue at the very back of the throat. It stops food from going into the windpipe (trachea) when swallowing. When the epiglottis becomes swollen and inflamed, it's called epiglottitis. Epiglottitis makes it hard to breathe. It gets worse quickly. If not treated, it can be life-threatening if there is so much swelling that air can’t get in or out of the lungs.

In the past, epiglottitis mainly affected children ages 3 to 6 years old. It was most often caused by infection with the bacteria Haemophilus influenzae type B (Hib). But today there is routine Hib vaccination for babies. So epiglottitis is now rare in young children. It is more often seen in adults and older children.

What causes epiglottitis in a child?

The main cause of epiglottitis in children is a bacterial infection that can be spread through the upper respiratory tract. Most cases are caused by the bacteria Hib.

Viruses do not cause epiglottitis. But a viral infection may make a bacterial infection more likely to occur. Epiglottitis in children may also be caused by injuries from:

• Breathing in smoke from a fire

• Swallowing a harsh chemical that burns the throat

• Swallowing something that is not food (foreign body)

In rare cases, a direct hit to the throat can also cause this condition. Smoking electronic cigarettes can also cause it.

Experts don’t exactly know why some children get this health problem and others don't. But they recommend the Hib vaccine for all children starting at age 2 months.

Which children are at risk for epiglottitis?

Children who don't get the Hib vaccine are at greater risk for epiglottitis. Children with a weak immune system due to certain medicines or diseases are also more likely to get this condition.

What are the symptoms of epiglottitis in a child?

Symptoms may be a bit different for each child. In some children, epiglottitis starts with symptoms of an upper respiratory infection. Symptoms may include:

• Sudden very sore throat

• Fever

• Drooling

• Trouble swallowing

• Muffled voice

• A high-pitched sound that mostly happens as the child breathes in (stridor).

As the condition gets worse, your child may have trouble breathing and talking. They may:

• Sit leaning forward

• Keep their mouths open with the chin thrust forward

• Look distressed or anxious

• Have a bluish skin tone (cyanosis)

How is epiglottitis diagnosed in a child?

Epiglottitis is an emergency. Call 911 right away if you think your child has it. This condition gets worse very quickly and is very dangerous. So don't try to treat it at home.

Don’t try to try to look at your child’s throat at home or make your child lie down. Don't offer them food or water. This can cause vomiting and more swelling that may fully block the airway.

The main concern is to make sure your child can breathe. Your child will need to be taken to the hospital. Treatment will typically begin as soon as possible to make sure of correct breathing and blood oxygen levels.

Once your child’s breathing and other vitals are under control, a healthcare provider will look at your child’s airway. This is often done in an operating room. That way the provider can act quickly to clear airways if they get blocked.

Other tests your child may have include:

• Chest or neck X-ray

• Blood tests

• Throat swab culture

How is epiglottitis treated in a child?

The treatment for epiglottitis calls for emergency care right away to stop the airway from being blocked. The medical staff will put in a breathing tube right away. They'll closely watch your child’s airway. Your child may need a machine (ventilator) to help them breathe.

Treatment may also include:

• IV (intravenous) therapy with antibiotics if the cause is a bacterial infection

• Steroid medicine to ease airway swelling

• IV fluids until the child can swallow again

How well your child recovers is related to how quickly treatment begins in the hospital. Once your child’s airway is safe and antibiotics are started, epiglottitis often stops getting worse within 24 hours. A full recovery takes longer and depends on your child’s condition.

What are the possible complications of epiglottitis in a child?

Epiglottitis may lead to:

• Cellulitis

• Abscess

• Fluid buildup in the lungs (pulmonary edema)

• Hypoxic brain injury (due to low oxygen)

• Pneumonia

• Meningitis

• Respiratory arrest

• Death

How can I help prevent epiglottitis in my child?

Epiglottitis that is caused by the bacteria Hib can be prevented with a vaccine. Once vaccinated, your child will have a lower chance of getting the condition.

Epiglottitis caused by other germs can’t be prevented at this time. But such cases are much less common. To help prevent the spread of airborne viruses, you and your child should:

• Stay away from people who are sick

• Cover your mouth with the inside of your elbow or with a tissue when sneezing or coughing

• Wash hands with soap and clean, running water

Experts recommend infants get 3 to 4 doses of the Hib vaccine. The main doses are given at ages 2 and 4 months or at ages 2, 4, and 6 months, based on the vaccine brand used by your healthcare provider. Your child will need a booster dose at age 12 to 15 months.

If your child has epiglottitis, family members or other close contacts may be treated with rifampin. This medicine helps prevent the condition in people who may have been exposed to it.

When should I call my child’s healthcare provider?

Epiglottitis is a health emergency. Call 911 right away if you think your child may have it.

Key points about epiglottitis in children

• Epiglottitis is when the epiglottis becomes swollen and inflamed. Call 911 if you think your child has epiglottitis. It can be a life-threatening condition.

• Symptoms are usually sudden. They include severe sore throat, trouble swallowing, and problems breathing.

• Most cases in children are caused by the bacteria Hib.

• Treatment involves emergency care and the opening the child’s airway with a breathing tube. Your child may also get antibiotics or other medicines.

• The Hib vaccine can prevent most cases of epiglottitis.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also, write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also, know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child doesn't take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.