Epiglottitis

Following the introduction of the Haemophilus influenza type b (Hib) vaccination in 1992, childhood epiglottitis has become rare. It can also be caused by the same aerobes that cause peri-tonsillar abscesses. However, children who are fully immunised can still get Hib culture positive epiglottitis.

Onset

There is a rapid onset of pyrexia, sore throat, muffled speech, drooling and stridor. The child usually looks unwell; sitting forwards, mouth open, drooling with tongue protruding. [36]

The child should reassured. Do not attempt any intervention that upsets the child nor should you undertake oropharyngeal inspection as this could precipitate complete airway obstruction.

Management

Management of this condition remains controversial. The cornerstone is not to distress the child as this can precipitate complete airway obstruction.

Oxygen should be administered if the child is hypoxic.

In the first instance, intravenous antibiotics should be administered, if intravenous access can be achieved without distress.

Treatment choice is by hospital guideline with a third-generation cephalosporin being a reasonable choice.

Children under 6 years of age require urgent intubation, ideally in theatre by an experienced anaesthetist with an ENT surgeon present. [37] If there is no time to transfer the child to theatre, then a difficult intubation trolley and cricothyroidotomy kit must be ready.

In those over the age of 6 years, observation may be an option following consultation with an ENT and PICU consultant. The average time for children to remain intubated is 48 to 96 hours. Extubation occurs when direct visualisation of the epiglottis confirms that the inflammation of the epiglottis and surrounding tissues has resolved. [38]