Epiglottitis in Children – Causes, Symptoms and Treatment

Epiglottitis is a potentially life-threatening disease characterized by swelling and inflammation of the epiglottis leading to obstructed airflow to the lungs. Epiglottis is a cartilage flap at the base of the tongue and covers the windpipe. It functions as a valve, preventing food and fluids from entering the food pipe. Epiglottitis requires immediate medical attention, prompt diagnosis, and treatment. Different factors are responsible for causing swollen epiglottis in children resulting from epiglottitis, including injury to the throat, burns from hot liquids, or smoking. The most common reason behind an infected pediatric epiglottis is a bacterial infection caused by Hib bacteria.

What Is Epiglottitis?

The epiglottis, a flap-like tissue present at the back of the throat, prevents food and liquids from entering the windpipe while swallowing. In rare conditions, the epiglottis gets infected, usually by a bacteria, causing a severe infection called Epiglottitis.

Epiglottitis or Supraglottitis, is an inflammation of structures present above the glottis, most commonly caused by Hib bacterial infection. The common site of swelling during this condition is the epiglottis. However, epiglottitis can also affect structures including arytenoid soft tissues and, sometimes, the uvula.

Epiglottitis should not be confused with visible epiglottis in children, which is a rare anatomical condition, usually asymptomatic without any medical intervention. Epiglottitis in kids is a life-threatening condition because swollen epiglottis can block the windpipe and cause disturbances in normal breathing.

Causes of Epiglottitis

• Epiglottitis is commonly caused by a bacterial infection. The most common bacterial strain responsible for this condition is Haemophilus influenza type B or Hib.
• Streptococcus A, B, or C and Streptococcus pneumonia are some other strains of bacteria that may cause epiglottitis.
• Few viruses associated with chickenpox and shingles, fungi associated with diaper rash, or yeast infections may be the contributing factors in epiglottitis.

Other causes of epiglottitis include:

• swallowing a foreign object
• traumatic throat injuries
• burning the throat from heat sources or steam
• inhaling chemical substances and chemical burns

Which Kids Are at a Greater Risk of Epiglottitis?

Epiglottitis can happen to anyone; however, there are several factors that increase the risk of developing the infection in epiglottis in a child’s throat. The factors include:

• Age: Children less than 12 months of age are at a higher risk of catching the disease because they do not complete the vaccination for the same.
• Sex: It is seen that epiglottis affects more males than females.
• Environment: Densely populated environments such as child care centers may increase the exposure to different infections, including epiglottitis.
• Weak immune system: Weak immunity makes it more difficult for the body to protect from infections. Epiglottitis develops easily in children whose immune system is compromised by illness or other conditions.

Symptoms of Epiglottitis

Symptoms of epiglottitis are common regardless of the reason. The symptoms of epiglottitis develop pretty fast in children, within an hour. For adults, signs and symptoms are almost similar but may develop more slowly, over days rather than hours. The most common symptoms of epiglottitis in infants and children are:

• High fever
• Sore throat
• Difficulty in swallowing
• Stridor (abnormal high pitched sound while breathing)
• Restlessness and anxious behavior
• Increased difficulty when laying down
• Drooling
• In extreme cases, complete airway blockage, leading to discoloration of the skin.

Diagnosis of Epiglottitis

Epiglottitis is a severe condition and requires medical attention. If suspected, one should always consult a doctor. There should be no attempt to inspect the throat of anyone suspected of having epiglottitis at home. To support the diagnosis, the doctor may ask to go for any of the following tests:

• An X-ray or CT scan of the throat and chest to determine the severity of the infection and inflammation.
• An X-ray of the neck to check for a “thumb sign” of epiglottis on a lateral soft tissue, signaled by an enlarged or swollen epiglottis.
• The doctor may check for pharynx inflammation with a stiff, cherry red, and swollen epiglottis.
• Blood cultures to check for bacteria or a virus to determine the cause of the infection.
• A laryngoscopy to examine the throat with a small camera.
• Blood test to check the white blood cell count (a high count implies the immune system is fighting an infection).

Complications of Epiglottitis

Acute epiglottitis in children can lead to several complications such as swollen epiglottis and surrounding tissues. Acute issues also lead to airway obstruction, which can lead to respiratory arrest and death from hypoxia. Other common complications are the following:

• Respiratory failure is one of the most common and severe complications – epiglottitis causes the epiglottis to swell, leading to partial or complete blockage in the airway. In turn, this can lead to respiratory failure, in which the oxygen level in the blood drops down significantly, threatening life.
• Cardiac arrest is another complication arising from epiglottitis due to improper flow of oxygen in the bloodstream.
• The Hib bacteria causing epiglottitis can spread the infections elsewhere in the body, causing pneumonia, meningitis, cellulitis, otitis media, or septic arthritis.
• In extreme cases, if epiglottitis is left untreated, it can lead to cerebral anoxia, septic shock, pulmonary edema, or even death from asphyxia.

Treatment for Epiglottitis

• Epiglottitis is a grave condition that needs immediate attention to prevent further complications. The child suffering from the disease needs extensive care while their airways should be closely monitored.
• Intravenous (IV) therapy with antibiotics to fight off bacterial infections.
• Steroid medications to ease airway swelling
• Oxygen humidification
• Intravenous fluid dips to maintain fluid levels until the child can swallow normally.
• A breathing tube can be inserted into the windpipe through the nose to establish normal breathing.
• The patient should keep up with all the follow-up appointments with the doctor and continue taking all the prescribed medications.

How to Prevent Epiglottitis in Children?

• The best way to prevent epiglottitis in children is to ensure up-to-date vaccination. The vaccination to prevent epiglottitis caused by the Hib bacteria starts at the age of 2 months. An underdeveloped immune system in children increases the risk of contracting epiglottitis from Hib bacteria.
• Hands should be washed frequently, and avoid touching eyes, nose, and mouth with your fingers
• Avoid sharing personal items
• Use alcohol-free sanitizer or soap and water to maintain cleanliness
• Necessary precautions should be taken around people with constant cough and sneeze
• Protect throat from injuries from hot liquids, steam, or smoking

When Should You Contact a Doctor?

Epiglottitis is a medical emergency condition as inflammation or swelling in epiglottis can restrict oxygen flow into the lungs. Seek immediate medical supervision if a child is suspected of having epiglottitis. While waiting for medical care, do not attempt to examine the child’s throat or place anything in their mouth, and don’t lay them on their back as this may worsen the symptoms. Be calm and try not to panic or cause distress around the patient. An individual should directly contact the emergency medical service if the following symptoms and signs are present:

• severely sore throat
• muffled or distorted voice
• fever
• difficulty in swallowing
• increased heart rate
• irritation, restlessness, or anxiety
• drooling
• respiratory issues such as shortness of breath, shallow breathing, pale appearance, difficulty in lying down

Epiglottitis is a serious life-threatening condition and requires immediate medical attention and care. When suspected of having epiglottitis, a person should be immediately taken to a doctor, especially children with acute respiratory issues such as asthma. With early diagnosis and in-time treatment, a person with epiglottitis condition can recover quite well. But when neglected, and the individual is not taken to hospital on time, not diagnosed appropriately, there is a risk of prolonged physical handicap or even death.

Proper Hib vaccination largely prevents the occurrence of epiglottitis, but if contracted, the condition remains worrisome. If you or anyone in your family shows the symptoms of epiglottitis, seek immediate emergency help. With prompt diagnosis, extensive treatment, and care, life-threatening complications arising from epiglottitis can be avoided.

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