COMMON INFECTIONS OF CHILDHOOD: EPIGLOTTITIS
Epiglottitis is less common than croup but more serious. It occurs most commonly in the toddler and preschool age group.
Cause
Epiglottitis is caused by a germ (Haemophilus influenzae) which causes inflammation and swelling of the epiglottis. The epiglottis normally sits at the top of the windpipe and prevents food and liquid entering the windpipe during swallowing. When it is inflamed and swollen, the epiglottis blocks air flow, causing breathing difficulty and marked distress.
Clinical features
The onset of epiglottitis is very rapid. Unlike croup, where the child has symptoms of a cold before he develops a barking cough and stridor, epiglottitis develops rapidly in a child who has previously been perfectly well. Within a few hours the child is often desperately sick. He looks toxic and unwell, pale, with saliva drooling from his open mouth. He will often have a soft snoring noise when he breathes, and will sit well forward, refusing to lie down because it causes him further respiratory distress. He is irritable and restless, feels hot, and it is difficult to console him.
No investigations are indicated. The diagnosis of epiglottitis is made on the basis of a very rapid onset of symptoms in a previously well child, and characteristic clinical signs. In fact, no investigations or procedures (such as taking blood, measuring temperature) etc. should be performed if epiglottitis is suspected because they may distress the child and precipitate obstruction of the windpipe.
If epiglottitis is suspected, the child must be transferred immediately to a hospital which has an intensive care unit. There a breathing tube is usually inserted to help the child breathe, and antibiotics given intravenously.
When to see your doctor
Epiglottitis is a medical emergency, and if it is suspected then medical assessment must be obtained immediately. Do not delay — it is literally a matter of life and death.
Prevention
Epiglottitis is preventable by having your child vaccinated against Haemophilus influenzae. This is commonly called the Hib vaccine, and is now available in Australia. Make sure your child is fully immunised. This will prevent him from contracting this and other potentially fatal diseases.
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