The epiglottis is a tongue-like flap of tissue at the back of the throat. Ordinarily it prevents food and liquid from entering the windpipe when one swallows. In epiglottitis, a rare but serious condition, this structure becomes infected, usually by bacteria called Haemophilus influenzae type B. This condition is life-threatening, because when the epiglottis is swollen, it can block the trachea (windpipe) and interfere with normal breathing. Children between two and six years old are most susceptible to this problem. Fortunately, this condition is now uncommon thanks to the Hib vaccine, which prevents infections due to Haemophilus influenzae type B.
The infection begins with a sore throat and a fever that usually is greater than 101 degrees Fahrenheit (38.3 degrees Celsius) and quickly makes your child feel very sick. Her throat will become extremely sore. With each breath, she may make a harsh or raspy noise, called stridor. She may have such difficulty swallowing that she begins to drool. She probably will refuse to lie down and will be most comfortable sitting and leaning forward.
Treatment
If your child has an unusually sore throat and is drooling and/or breathing with difficulty, call your physician immediately. Because epiglottitis progresses so rapidly and has such serious consequences, do not attempt to treat it at home. After contacting your pediatrician, try to keep your child calm. Don’t try to examine her throat or insist that she lie down. Also, avoid offering food or water, because that might cause vomiting, which often makes breathing even more difficult.
If you take your child to the pediatrician during the early stages of epiglottitis, the doctor should be able to determine if your child has this condition without the need for X-rays. But if her condition has worsened, and she begins drooling or has hoarse breathing, your pediatrician will probably ask you to take your child directly to the hospital emergency room, and recommend that you call 911 so an ambulance can transport her. At the hospital, with the help of an anesthesiologist and an otolaryngologist (an ear, nose, and throat specialist; ENT), the doctor will X-ray your child’s epiglottis. If it is thought to be severely inflamed, your child will be taken to the operating room where an anesthetic will be given and a tube will be inserted into the trachea (windpipe), bypassing the swelling and allowing your child to breathe comfortably again. In very severe cases, a tracheostomy (a breathing tube placed into the trachea through a small incision in the neck) may be necessary, but this is done much less often now than in the past.
Your child also will be given antibiotics. All these decisions are likely to be made very quickly, and you may feel shocked that your child needs such extreme treatment for what looks like a simple though severe sore throat. It’s important to remember that epiglottitis progresses very rapidly and can become life-threatening if it goes untreated.
Prevention
The Hib vaccine is available to combat the bacteria that cause epiglottitis. Your child should receive the full series of the Hib vaccine, according to your pediatrician’s recommendations. However, even if she has had the vaccine, consult your doctor if you know there has been an exposure to another child who has the infection. Your physician might want to take added precautions.