Medical Conditions

Epiglottitis Warning Signs in Babies and Toddlers

Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist

Content reviewed against published AAP, CDC, NIH guidelines

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If your baby has been diagnosed with or you suspect epiglottitis warning signs in babies and toddlers, here is what the evidence says.

The short answer

Epiglottitis is a rare but serious infection where the epiglottis (the flap of tissue at the base of the tongue) becomes swollen and can block the airway. Thanks to the Hib vaccine, epiglottitis has become very uncommon in vaccinated children, but it still occurs rarely and is a medical emergency. It comes on rapidly and requires immediate emergency care. Knowing the warning signs can be life-saving.

Key takeaways

  • Epiglottitis is a rare but serious infection where the epiglottis (the flap of tissue at the base of the tongue) becomes swollen and can block the airway. Thanks to the Hib vaccine, epiglottitis has become very uncommon in vaccinated children, but it still occurs rarely and is a medical emergency. It comes on rapidly and requires immediate emergency care. Knowing the warning signs can be life-saving.
  • Usually normal when: Mild sore throat with a cold that does not affect breathing or swallowing
  • Call your doctor if: Your child has sudden onset of high fever, drooling, and difficulty swallowing
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
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What Parents Should Know

According to AAP, CDC, NIH guidelines, epiglottitis is a rare but serious infection where the epiglottis (the flap of tissue at the base of the tongue) becomes swollen and can block the airway. Thanks to the Hib vaccine, epiglottitis has become very uncommon in vaccinated children, but it still occurs rarely and is a medical emergency. It comes on rapidly and requires immediate emergency care. Knowing the warning signs can be life-saving. At 0-12 months, epiglottitis is extremely rare in infants under 1 year. If breathing difficulty develops suddenly in a young baby, other causes like bronchiolitis, croup, or a foreign body are much more likely. However, if your baby develops sudden high fever with drooling and obvious difficulty breathing, seek emergency care immediately. It is generally considered normal when mild sore throat with a cold that does not affect breathing or swallowing. However, you should contact your pediatrician promptly if your child has sudden onset of high fever, drooling, and difficulty swallowing.

Sources: [1], [2], [3]

Normal vs. Concerning

Usually Normal
Worth Discussing
Mild sore throat with a cold that does not affect breathing or swallowing
Your child has sudden onset of high fever, drooling, and difficulty swallowing
Barking cough with mild stridor that improves with cool air or steam (more likely croup)
Your child is sitting upright, leaning forward, and appears to be straining to breathe
A hoarse voice during a cold that does not worsen rapidly
Your child has a muffled or "hot potato" voice with drooling and fever

When to Seek Immediate Care

  • Your child has sudden onset of high fever, drooling, and difficulty swallowing
  • Your child is sitting upright, leaning forward, and appears to be straining to breathe
  • Your child has a muffled or "hot potato" voice with drooling and fever
  • Your child looks very ill, pale or bluish, and is struggling to breathe
  • Breathing difficulty is worsening rapidly over hours rather than days

By Age

What to expect by age

0-12 months

Epiglottitis is extremely rare in infants under 1 year. If breathing difficulty develops suddenly in a young baby, other causes like bronchiolitis, croup, or a foreign body are much more likely. However, if your baby develops sudden high fever with drooling and obvious difficulty breathing, seek emergency care immediately.

1-3 years

While rare in vaccinated children, epiglottitis can still occur. It typically comes on very quickly over just a few hours. Unlike croup, which causes a barking cough and usually worsens gradually, epiglottitis produces a toxic-appearing child with high fever, drooling, difficulty swallowing, a muffled or hoarse voice, and a preference for sitting upright and leaning forward to breathe (called the "tripod" or "sniffing" position). There is usually no barking cough.

What to Tell Your Pediatrician

  • Describe when you first noticed epiglottitis warning signs in babies and toddlers and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has a sore throat and is having mild difficulty swallowing but is breathing comfortably.
  • Mention if you are unsure whether your child's breathing sounds are concerning.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

What Should You Do?

When to take action

Probably normal when...
  • Mild sore throat with a cold that does not affect breathing or swallowing
  • Barking cough with mild stridor that improves with cool air or steam (more likely croup)
  • A hoarse voice during a cold that does not worsen rapidly
Mention at your next visit when...
  • Your child has a sore throat and is having mild difficulty swallowing but is breathing comfortably
  • You are unsure whether your child's breathing sounds are concerning
  • Your child has not received the Hib vaccine and develops a sore throat with fever
Act now when...
  • Your child has sudden onset of high fever, drooling, and difficulty swallowing
  • Your child is sitting upright, leaning forward, and appears to be straining to breathe
  • Your child has a muffled or "hot potato" voice with drooling and fever
  • Your child looks very ill, pale or bluish, and is struggling to breathe
  • Breathing difficulty is worsening rapidly over hours rather than days

What You Can Do at Home

  • Keep track of when you notice epiglottitis warning signs in babies and toddlers — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that mild sore throat with a cold that does not affect breathing or swallowing — this is generally within the range of normal.
  • At 0-12 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
  • Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
  • While monitoring at home, seek immediate care if your child has sudden onset of high fever, drooling, and difficulty swallowing.

My Baby Has Croup

Croup is a viral infection that causes a distinctive barking cough and sometimes noisy breathing, especially at night. Most cases are mild and can be managed at home with cool mist and comfort. However, if your baby is struggling to breathe, making high-pitched sounds when inhaling, or can't settle, seek immediate medical care.

My Baby Is Breathing Fast

Babies normally breathe faster than adults. A normal respiratory rate for a newborn is 30-60 breaths per minute, slowing to 20-40 by age 1. Brief episodes of faster breathing during excitement, crying, or feeding are normal. However, persistently rapid breathing (tachypnea) at rest, especially with other signs of respiratory distress, may indicate a lung or heart problem that needs prompt evaluation.

Baby Wheezing

Wheezing is a high-pitched whistling sound heard during breathing out, caused by narrowed airways. In babies, the most common cause is a viral infection like bronchiolitis (often RSV). Many babies wheeze once or twice during their first viral illnesses and never wheeze again. However, wheezing with breathing difficulty always warrants medical evaluation.

My Baby Has a Hoarse Voice

A hoarse voice in a baby can be caused by crying a lot, a mild illness, or reflux, and usually resolves on its own. If hoarseness lasts more than two weeks, is present from birth, or is accompanied by breathing difficulties, it could indicate a vocal cord issue or other structural problem that needs evaluation by a pediatric ENT.

Triage

Fever Decision Tree

Step-by-step guidance for evaluating your baby's fever by age and temperature.

Guide

When to Call the Doctor

General guide on when to call the pediatrician, visit urgent care, or go to the ER.

Frequently asked questions

Is epiglottitis warning signs in babies and toddlers normal?
Epiglottitis is a rare but serious infection where the epiglottis (the flap of tissue at the base of the tongue) becomes swollen and can block the airway. Thanks to the Hib vaccine, epiglottitis has become very uncommon in vaccinated children, but it still occurs rarely and is a medical emergency. It comes on rapidly and requires immediate emergency care. Knowing the warning signs can be life-saving.
When should I call the doctor about epiglottitis warning signs in babies and toddlers?
Your child has sudden onset of high fever, drooling, and difficulty swallowing Your child is sitting upright, leaning forward, and appears to be straining to breathe Your child has a muffled or "hot potato" voice with drooling and fever
When is epiglottitis warning signs in babies and toddlers normal?
Mild sore throat with a cold that does not affect breathing or swallowing Barking cough with mild stridor that improves with cool air or steam (more likely croup) A hoarse voice during a cold that does not worsen rapidly
What causes epiglottitis warning signs in babies and toddlers?
Epiglottitis is a rare but serious infection where the epiglottis (the flap of tissue at the base of the tongue) becomes swollen and can block the airway. Thanks to the Hib vaccine, epiglottitis has become very uncommon in vaccinated children, but it still occurs rarely and is a medical emergency. It comes on rapidly and requires immediate emergency care. Knowing the warning signs can be life-saving. Common explanations include: Mild sore throat with a cold that does not affect breathing or swallowing. Barking cough with mild stridor that improves with cool air or steam (more likely croup).
What should I mention to my pediatrician about epiglottitis warning signs in babies and toddlers?
You should mention epiglottitis warning signs in babies and toddlers at your next visit if: Your child has a sore throat and is having mild difficulty swallowing but is breathing comfortably. You are unsure whether your child's breathing sounds are concerning. Your child has not received the Hib vaccine and develops a sore throat with fever.
Is epiglottitis warning signs in babies and toddlers normal at 0-12 months?
Epiglottitis is extremely rare in infants under 1 year. If breathing difficulty develops suddenly in a young baby, other causes like bronchiolitis, croup, or a foreign body are much more likely. However, if your baby develops sudden high fever with drooling and obvious difficulty breathing, seek emergency care immediately.
Is epiglottitis warning signs in babies and toddlers normal at 1-3 years?
While rare in vaccinated children, epiglottitis can still occur. It typically comes on very quickly over just a few hours. Unlike croup, which causes a barking cough and usually worsens gradually, epiglottitis produces a toxic-appearing child with high fever, drooling, difficulty swallowing, a muffled or hoarse voice, and a preference for sitting upright and leaning forward to breathe (called the "tripod" or "sniffing" position). There is usually no barking cough.
Should I go to the ER for epiglottitis warning signs in babies and toddlers?
Seek emergency care if your child has sudden onset of high fever, drooling, and difficulty swallowing, or if your child is sitting upright, leaning forward, and appears to be straining to breathe. When in doubt, call your pediatrician's after-hours line for guidance.
Does epiglottitis warning signs in babies and toddlers go away on its own?
In many cases, epiglottitis warning signs in babies and toddlers resolves on its own, especially when mild sore throat with a cold that does not affect breathing or swallowing.
AAPCDCNIH

References

  1. [1]American Academy of Pediatrics. Epiglottitis. Red Book Online. AAP
  2. [2]Centers for Disease Control and Prevention. Haemophilus influenzae Disease (Including Hib). CDC
  3. [3]National Library of Medicine. Epiglottitis. StatPearls. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Epiglottitis Warning Signs in Babies and Toddlers.

Things to mention

  • Describe when you first noticed epiglottitis warning signs in babies and toddlers and how it has changed over time.
  • Note your baby's current age and which age-specific patterns you are seeing.
  • Mention if your child has a sore throat and is having mild difficulty swallowing but is breathing comfortably.
  • Mention if you are unsure whether your child's breathing sounds are concerning.
  • Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
  • Bring a list of any questions or observations you want to discuss at the appointment.

Observations to share

  • Your child has a sore throat and is having mild difficulty swallowing but is breathing comfortably
  • You are unsure whether your child's breathing sounds are concerning
  • Your child has not received the Hib vaccine and develops a sore throat with fever

Urgent signs to report immediately

  • Your child has sudden onset of high fever, drooling, and difficulty swallowing
  • Your child is sitting upright, leaning forward, and appears to be straining to breathe
  • Your child has a muffled or "hot potato" voice with drooling and fever

My notes

From ismybabyalright.com — free, evidence-based baby health guides

All content follows our editorial policy and is reviewed against published clinical guidelines.

2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members

Related Resources

Fever TriageWell-Baby Visit PrepMedicine Dosage CalculatorBaby Sign Language GuideEmergency ContactsBaby Tracker

Bottom line

Most cases of epiglottitis warning signs in babies and toddlers are normal. Talk to your pediatrician if your child has sudden onset of high fever, drooling, and difficulty swallowing.

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.

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My Baby Has Croup

Croup is a viral infection that causes a distinctive barking cough and sometimes noisy breathing, especially at night. Most cases are mild and can be managed at home with cool mist and comfort. However, if your baby is struggling to breathe, making high-pitched sounds when inhaling, or can't settle, seek immediate medical care.

My Baby Is Breathing Fast

Babies normally breathe faster than adults. A normal respiratory rate for a newborn is 30-60 breaths per minute, slowing to 20-40 by age 1. Brief episodes of faster breathing during excitement, crying, or feeding are normal. However, persistently rapid breathing (tachypnea) at rest, especially with other signs of respiratory distress, may indicate a lung or heart problem that needs prompt evaluation.

Baby Wheezing

Wheezing is a high-pitched whistling sound heard during breathing out, caused by narrowed airways. In babies, the most common cause is a viral infection like bronchiolitis (often RSV). Many babies wheeze once or twice during their first viral illnesses and never wheeze again. However, wheezing with breathing difficulty always warrants medical evaluation.

My Baby Has a Hoarse Voice

A hoarse voice in a baby can be caused by crying a lot, a mild illness, or reflux, and usually resolves on its own. If hoarseness lasts more than two weeks, is present from birth, or is accompanied by breathing difficulties, it could indicate a vocal cord issue or other structural problem that needs evaluation by a pediatric ENT.

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