Medical Conditions

Retropharyngeal Abscess (Deep Neck Infection)

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

Content reviewed against published AAP, AAO-HNS, NIH guidelines

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If your baby has been diagnosed with or you suspect retropharyngeal abscess (deep neck infection), here is what the evidence says.

The short answer

A retropharyngeal abscess is a serious deep neck infection involving a collection of pus in the space behind the throat (pharynx). It is most common in children under age 6, typically following an upper respiratory infection or pharyngitis. Symptoms include high fever, neck stiffness or refusal to move the neck, drooling, difficulty swallowing, refusal to eat, a muffled voice, and sometimes noisy breathing. This is a medical emergency that requires prompt hospital evaluation, IV antibiotics, and often surgical drainage. With timely treatment, most children recover fully.

Key takeaways

  • A retropharyngeal abscess is a serious deep neck infection involving a collection of pus in the space behind the throat (pharynx). It is most common in children under age 6, typically following an upper respiratory infection or pharyngitis. Symptoms include high fever, neck stiffness or refusal to move the neck, drooling, difficulty swallowing, refusal to eat, a muffled voice, and sometimes noisy breathing. This is a medical emergency that requires prompt hospital evaluation, IV antibiotics, and often surgical drainage. With timely treatment, most children recover fully.
  • Usually normal when: Your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally
  • Call your doctor if: Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately
  • Varies by age — see the age-by-age breakdown below
“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.”
— Fever and Your Child, American Academy of Pediatrics (AAP)

Parents everywhere have the same worry. You are doing the right thing by looking into it.

What Parents Should Know

According to AAP, AAO-HNS, NIH guidelines, a retropharyngeal abscess is a serious deep neck infection involving a collection of pus in the space behind the throat (pharynx). It is most common in children under age 6, typically following an upper respiratory infection or pharyngitis. Symptoms include high fever, neck stiffness or refusal to move the neck, drooling, difficulty swallowing, refusal to eat, a muffled voice, and sometimes noisy breathing. This is a medical emergency that requires prompt hospital evaluation, IV antibiotics, and often surgical drainage. With timely treatment, most children recover fully. At 0-12 months, retropharyngeal abscesses are uncommon in very young infants but can occur. Symptoms in this age group may be nonspecific and include fever, irritability, poor feeding, drooling, and stiff or extended neck posture. Because babies cannot describe their symptoms, a high fever combined with refusal to feed and unusual neck positioning should prompt medical evaluation. Retropharyngeal lymph nodes are proportionally larger in young children, which is why this infection is more common in the pediatric age group. It is generally considered normal when your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally. However, you should contact your pediatrician promptly if your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately.

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

Normal vs. Concerning

Usually Normal
Worth Discussing
Your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally
Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately
Your child had a sore throat that is improving day by day with supportive care
Your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911
Mild neck stiffness that resolves quickly and is associated with sleeping in an awkward position rather than infection
Your child appears very ill, lethargic, or is unable to open their mouth or swallow their own saliva

When to Seek Immediate Care

  • Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately
  • Your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911
  • Your child appears very ill, lethargic, or is unable to open their mouth or swallow their own saliva

By Age

What to expect by age

0-12 months

Retropharyngeal abscesses are uncommon in very young infants but can occur. Symptoms in this age group may be nonspecific and include fever, irritability, poor feeding, drooling, and stiff or extended neck posture. Because babies cannot describe their symptoms, a high fever combined with refusal to feed and unusual neck positioning should prompt medical evaluation. Retropharyngeal lymph nodes are proportionally larger in young children, which is why this infection is more common in the pediatric age group.

1-3 years

This is the peak age for retropharyngeal abscesses. The typical scenario is a toddler who has had a cold or sore throat that seems to worsen rather than improve, developing high fever, neck stiffness (especially refusal to extend or turn the neck), drooling, difficulty swallowing, and a muffled or changed voice. Your child may refuse to eat or drink and appear very uncomfortable. Diagnosis involves a CT scan of the neck with contrast. Treatment requires hospitalization for IV antibiotics, and if a drainable abscess has formed, surgical drainage is performed under general anesthesia.

3-6 years

Children in this age group can sometimes describe throat pain, difficulty swallowing, or neck pain, which may help with earlier detection. Retropharyngeal abscesses can develop rapidly, sometimes within 24-48 hours of symptom onset. Complications, while uncommon with prompt treatment, can include airway obstruction, spread of infection to the chest (mediastinitis), or sepsis. If your child has a sore throat or cold that takes a sudden turn for the worse with high fever and neck stiffness, seek emergency evaluation.

6+ years

Retropharyngeal abscesses become less common after age 6 because the retropharyngeal lymph nodes naturally atrophy. In older children and adolescents, similar deep neck infections may present as peritonsillar abscesses or parapharyngeal abscesses. Symptoms and treatment principles are similar. With appropriate antibiotic treatment and surgical drainage when needed, the prognosis is excellent and recurrence is uncommon.

What to Tell Your Pediatrician

  • Describe when you first noticed retropharyngeal abscess (deep neck infection) 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 that seems unusually severe or is worsening after 2-3 days rather than improving.
  • Mention if your child has neck stiffness or reluctance to move their neck along with a fever.
  • 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...
  • Your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally
  • Your child had a sore throat that is improving day by day with supportive care
  • Mild neck stiffness that resolves quickly and is associated with sleeping in an awkward position rather than infection
Mention at your next visit when...
  • Your child has a sore throat that seems unusually severe or is worsening after 2-3 days rather than improving
  • Your child has neck stiffness or reluctance to move their neck along with a fever
  • Your child is drooling more than usual or having difficulty swallowing during what seemed like a routine cold
Act now when...
  • Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately
  • Your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911
  • Your child appears very ill, lethargic, or is unable to open their mouth or swallow their own saliva

What You Can Do at Home

  • Keep track of when you notice retropharyngeal abscess (deep neck infection) — noting the time of day, duration, and any triggers can help your pediatrician.
  • Remember that your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally — 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 high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately.

My Baby Was Born with Blocked Nasal Passages (Choanal Atresia)

Choanal atresia is a condition present at birth where one or both nasal passages are blocked by bone or tissue. Since newborns are obligate nose-breathers (they breathe primarily through their nose), bilateral choanal atresia (both sides blocked) is a medical emergency that is usually detected immediately after birth. Unilateral choanal atresia (one side blocked) may not be diagnosed until later. Treatment is surgical, and outcomes are generally very good. About half of babies with choanal atresia have other associated conditions, so a thorough evaluation is important.

Stridor (Noisy Breathing) in Babies

Stridor is a high-pitched, squeaky or whistling sound heard when a baby breathes in (and sometimes out). It is caused by narrowing or obstruction of the upper airway. The most common cause in infants is laryngomalacia (a floppy voice box), which is usually harmless and outgrown. However, stridor can also be caused by croup, vocal cord problems, airway malformations, or foreign body aspiration. New-onset stridor or stridor with breathing difficulty always needs 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.

Milestone

Month-by-Month Development

Detailed monthly development guides from birth through 24 months.

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 retropharyngeal abscess (deep neck infection) normal?
A retropharyngeal abscess is a serious deep neck infection involving a collection of pus in the space behind the throat (pharynx). It is most common in children under age 6, typically following an upper respiratory infection or pharyngitis. Symptoms include high fever, neck stiffness or refusal to move the neck, drooling, difficulty swallowing, refusal to eat, a muffled voice, and sometimes noisy breathing. This is a medical emergency that requires prompt hospital evaluation, IV antibiotics, and often surgical drainage. With timely treatment, most children recover fully.
When should I call the doctor about retropharyngeal abscess (deep neck infection)?
Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately Your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911 Your child appears very ill, lethargic, or is unable to open their mouth or swallow their own saliva
When is retropharyngeal abscess (deep neck infection) normal?
Your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally Your child had a sore throat that is improving day by day with supportive care Mild neck stiffness that resolves quickly and is associated with sleeping in an awkward position rather than infection
What causes retropharyngeal abscess (deep neck infection)?
A retropharyngeal abscess is a serious deep neck infection involving a collection of pus in the space behind the throat (pharynx). It is most common in children under age 6, typically following an upper respiratory infection or pharyngitis. Symptoms include high fever, neck stiffness or refusal to move the neck, drooling, difficulty swallowing, refusal to eat, a muffled voice, and sometimes noisy breathing. This is a medical emergency that requires prompt hospital evaluation, IV antibiotics, and often surgical drainage. With timely treatment, most children recover fully. Common explanations include: Your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally. Your child had a sore throat that is improving day by day with supportive care.
What should I mention to my pediatrician about retropharyngeal abscess (deep neck infection)?
You should mention retropharyngeal abscess (deep neck infection) at your next visit if: Your child has a sore throat that seems unusually severe or is worsening after 2-3 days rather than improving. Your child has neck stiffness or reluctance to move their neck along with a fever. Your child is drooling more than usual or having difficulty swallowing during what seemed like a routine cold.
Is retropharyngeal abscess (deep neck infection) normal at 0-12 months?
Retropharyngeal abscesses are uncommon in very young infants but can occur. Symptoms in this age group may be nonspecific and include fever, irritability, poor feeding, drooling, and stiff or extended neck posture. Because babies cannot describe their symptoms, a high fever combined with refusal to feed and unusual neck positioning should prompt medical evaluation. Retropharyngeal lymph nodes are proportionally larger in young children, which is why this infection is more common in the pediatric age group.
Is retropharyngeal abscess (deep neck infection) normal at 1-3 years?
This is the peak age for retropharyngeal abscesses. The typical scenario is a toddler who has had a cold or sore throat that seems to worsen rather than improve, developing high fever, neck stiffness (especially refusal to extend or turn the neck), drooling, difficulty swallowing, and a muffled or changed voice. Your child may refuse to eat or drink and appear very uncomfortable. Diagnosis involves a CT scan of the neck with contrast. Treatment requires hospitalization for IV antibiotics, and if a drainable abscess has formed, surgical drainage is performed under general anesthesia.
Should I go to the ER for retropharyngeal abscess (deep neck infection)?
Seek emergency care if your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately, or if your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911. When in doubt, call your pediatrician's after-hours line for guidance.
Does retropharyngeal abscess (deep neck infection) go away on its own?
In many cases, retropharyngeal abscess (deep neck infection) resolves on its own, especially when your child has a cold with mild sore throat, low-grade fever, and is still drinking fluids and moving their neck normally. By 6+ years, retropharyngeal abscesses become less common after age 6 because the retropharyngeal lymph nodes naturally atrophy. In older children and adolescents, similar deep neck infections may present as peritonsillar abscesses or parapharyngeal abscesses. Symptoms and treatment principles are similar. With appropriate antibiotic treatment and surgical drainage when needed, the prognosis is excellent and recurrence is uncommon.
AAPAAO-HNSNIH

References

  1. [1]American Academy of Pediatrics. Retropharyngeal Abscess. Red Book: Report of the Committee on Infectious Diseases. AAP
  2. [2]American Academy of Otolaryngology-Head and Neck Surgery. Deep Neck Infections. AAO-HNS
  3. [3]National Library of Medicine. Retropharyngeal Abscess. StatPearls, NIH. NIH

Doctor Visit Checklist

Bring this checklist to your next pediatrician visit to discuss Retropharyngeal Abscess (Deep Neck Infection).

Things to mention

  • Describe when you first noticed retropharyngeal abscess (deep neck infection) 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 that seems unusually severe or is worsening after 2-3 days rather than improving.
  • Mention if your child has neck stiffness or reluctance to move their neck along with a fever.
  • 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 that seems unusually severe or is worsening after 2-3 days rather than improving
  • Your child has neck stiffness or reluctance to move their neck along with a fever
  • Your child is drooling more than usual or having difficulty swallowing during what seemed like a routine cold

Urgent signs to report immediately

  • Your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately
  • Your child has noisy breathing, stridor, or appears to be struggling to breathe along with a neck infection -- call 911
  • Your child appears very ill, lethargic, or is unable to open their mouth or swallow their own saliva

My notes

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

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Related Resources

Fever TriageWell-Baby Visit PrepMedicine Dosage CalculatorEmergency ContactsBaby Tracker

Bottom line

Most cases of retropharyngeal abscess (deep neck infection) are normal. Talk to your pediatrician if your child has high fever with neck stiffness, drooling, difficulty swallowing, and refusal to eat or drink -- go to the emergency room immediately.

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 Was Born with Blocked Nasal Passages (Choanal Atresia)

Choanal atresia is a condition present at birth where one or both nasal passages are blocked by bone or tissue. Since newborns are obligate nose-breathers (they breathe primarily through their nose), bilateral choanal atresia (both sides blocked) is a medical emergency that is usually detected immediately after birth. Unilateral choanal atresia (one side blocked) may not be diagnosed until later. Treatment is surgical, and outcomes are generally very good. About half of babies with choanal atresia have other associated conditions, so a thorough evaluation is important.

Stridor (Noisy Breathing) in Babies

Stridor is a high-pitched, squeaky or whistling sound heard when a baby breathes in (and sometimes out). It is caused by narrowing or obstruction of the upper airway. The most common cause in infants is laryngomalacia (a floppy voice box), which is usually harmless and outgrown. However, stridor can also be caused by croup, vocal cord problems, airway malformations, or foreign body aspiration. New-onset stridor or stridor with breathing difficulty always needs 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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Adenoid Hypertrophy and Breathing

Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.