Epiglottitis in children: emergency signs, treatment and prevention

The epiglottis is the flap that covers the windpipe when you swallow. In epiglottitis it becomes swollen. The NHS explains that it can block the windpipe, even when you are not swallowing, making it difficult to breathe.

The NHS page covers both adults and children, and the key message for parents is that a child who is finding it very difficult to breathe, has a very sore throat and is drooling needs emergency help straight away.

The NHS says the main symptom is finding it very difficult to breathe, usually coming on quickly. Breathing may be very fast or slow, easier when leaning forward, or make a high-pitched, rasping sound when breathing in. A child may not want to lie down and will lean forward with the neck pushed out while sitting.

• A very sore throat and a high temperature.

• A hoarse (croaky) voice.

• Finding it painful and difficult to swallow, and drooling.

• Pale, grey or blue-tinged skin (cyanosis), which may be easier to see on the palms, soles, lips, gums and inside the eyelids on brown or black skin.

• Being extremely tired, or very restless and irritable.

The NHS says to call 999 if you think you or your child may have epiglottitis. Stay upright until help arrives, because lying down can make symptoms worse. Do not drive yourself to A&E; the person you speak to at 999 will give you advice about what to do.

The NHS guidance gives no further home measures, because treatment has to be given in hospital. Staying upright and waiting for the ambulance while following the 999 call handler's advice is the right approach.

The NHS says treatment is in hospital. You will usually need oxygen through a tube in your nose or a face mask. You may also need a breathing tube put down your throat, or into a hole made in the neck (tracheostomy), if breathing is very difficult. Antibiotics are given through a vein if an infection has caused the symptoms.

Tests may be carried out to check how swollen the windpipe is and find out the cause. The NHS lists laryngoscopy, where a tube with a camera is used to look at the throat, a throat swab, blood tests, and an X-ray or CT scan. With treatment most people make a full recovery, although a stay of a few days in hospital may be needed.

The NHS says epiglottitis is usually caused by a type of bacteria called Haemophilus influenzae type b (Hib), which is spread through coughing and sneezing, or touching objects and surfaces that have the germ on them.

Other causes include injuring the throat, such as being hit in the throat or drinking very hot liquids, and smoking, especially illegal drugs such as cannabis or crack cocaine. A weakened immune system can also raise the chance of getting epiglottitis.

The NHS says the 6-in-1 vaccine, which includes protection against Hib, is offered to children as part of the NHS vaccination schedule, in 4 doses at 8 weeks, 12 weeks, 16 weeks and 18 months. The NHS vaccine page lists the six illnesses it protects against as diphtheria, hepatitis B, Hib, polio, tetanus and whooping cough, and says missed doses can still be given up to the age of 10.

If you or your child were not vaccinated when young, ask a GP about how to get vaccinated. Not smoking can also reduce your chance of getting epiglottitis.

The NHS says most people make a full recovery with treatment. After discharge, follow the instructions given by the hospital team and attend any follow-up. It is also sensible to check that your child's vaccination record is complete, so any missed doses can be given.

The experience can be frightening for children and parents. It is reasonable to ask the ward team or your GP for support if either of you is anxious afterwards.

Epiglottitis is treated as an emergency in NHS hospitals, with ambulance, emergency department, anaesthetic and ENT teams involved. There is no meaningful choice of pathway in the acute phase: call 999.

Routine childhood vaccination is free on the NHS. If your child's records are incomplete, your GP surgery can book catch-up doses.