Epiglottitis, Child

At the back of the tongue is a small flap of tissue called the epiglottis. It hangs over the windpipe. This is not to be confused with the uvula, which is the small structure that hangs from the roof at the back of the mouth. The epiglottis protects the windpipe during swallowing. It stops food and liquid from going down the windpipe. If the epiglottis becomes inflamed, the condition is called epiglottitis. Inflammation of the epiglottis is commonly caused by infection. Epiglottitis is an emergency. An infected epiglottis swells and can block air from going into the windpipe, making it hard to breathe. In severe cases, it can even lead to respiratory arrest. A child with epiglottitis needs treatment right away.

CAUSES

In children, epiglottitis is usually caused by bacteria. The bacteria infect the nose and throat. The result is an upper respiratory tract infection. One type of bacteria that causes epiglottitis is called Haemophilus influenza type B (Hib). Factors that increase your child's risk for developing this infection include:

  • Not being vaccinated against Hib.

  • Being around other people with upper respiratory tract infections. This might happen at home, school, or daycare.

  • Being younger than 2 months old.

  • Being a boy.

SYMPTOMS

At first, it might seem like your child has a normal cold or the flu. However, with epiglottitis, symptoms quickly get worse. Symptoms of epiglottitis include:

  • Very sore throat.

  • Irritability or appearing very ill.

  • High fever.

  • Drooling.

  • Trouble swallowing.

  • Muffled voice or crying.

  • Rapid and noisy breathing.

  • Needing to sit up and lean forward to breathe (tripod position).

DIAGNOSIS

A quick diagnosis is important. This is needed so the airway does not become blocked. Your child's caregiver may perform:

  • X-rays. These are taken from the side of the neck. They will show if the epiglottis is blocking the airway.

  • Blood tests. These check for infection. They also show what bacteria are causing an infection.

  • A throat exam. In certain cases the caregiver may look at the epiglottis with a small mirror or a small, lighted tube. Depending on the severity, the caregiver may require a specialist to perform this evaluation in a controlled setting in the hospital.

TREATMENT

  • The airway must be clear. If the airway is blocked:

  • An endotracheal tube may be put in the airway. This is a thin, soft tube. It keeps the airway open so the child can breathe.

  • A tracheostomy may be done. This could be needed if an endotracheal tube cannot get past the epiglottis. An opening is made through the child's neck, and a tracheostomy tube is put in through the opening. This keeps the airway open.

  • If the airway is not blocked, your child may still need to stay in a hospital. This may be the case if there is a very bad infection. Your child will need to be watched closely.

  • Antibiotic medicine may be given through an intravenous line (IV). A needle is put into a vein in the child's hand or arm. Medicine can flow into the body through the IV.

  • Liquid fluids and food may need to be given through the IV. This may be done if your child cannot swallow.

  • Steroid medicines may be given to help decrease swelling.

HOME CARE INSTRUCTIONS

  • Give medicines as prescribed by the caregiver. Follow the directions carefully.

  • If prescribed, give antibiotics as directed. Make sure your child finishes them even if he or she starts to feel better.

  • If a tracheostomy was done, the caregiver will explain what you need to do at home. Make sure you understand the instructions before taking your child home. If you have questions, call the caregiver right away.

  • Make sure your child drinks enough liquids to keep his or her urine clear or pale yellow.

  • At first, give your child only soft foods. Make sure your child can keep these foods down. Then, slowly change to regular foods.

  • Your child should stay as quiet as possible for several days.

  • Family members and other people who come in contact with your child may need to take an antibiotic to prevent infection. Follow the caregiver's instructions.

  • Keep all follow-up appointments. This is how the caregiver can make sure your child is getting better.

SEEK MEDICAL CARE IF:

Your child develops a cough or sore throat.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Your child has a very bad sore throat.

  • Your child has trouble swallowing.

  • Your child has trouble breathing.

  • Your child who is younger than 3 months has a fever.

  • Your child who is older than 3 months has a fever and persistent symptoms.

  • Your child who is older than 3 months has a fever and symptoms suddenly get worse.

  • Your child is drooling more than normal.

  • Your child needs to sit forward with the neck extended in order to breathe.

  • Your child is very irritable or appears to be very sick.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your child's condition.

  • Will get help right away if your child is not doing well or gets worse.