Epiglottitis Warning Signs in Babies and Toddlers
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.
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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 Should You Do?
When to take action
- 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
- 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
- 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
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
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.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.