Childhood Respiratory Diseases Epiglottitis

Epiglottitis, an inflammation of the epiglottis, is a rare but serious condition usually caused by an infection of H. influenza B (HIB) bacteria. Epiglottitis can cause severe breathing difficulties and, in the absence of immediate medical attention, can be fatal. While epiglottitis may occur at any age, children aged two to six years old are most vulnerable to the condition.

The Function of the Epiglottis

The epiglottis is a small flap of skin at the back of the throat that moves to close the windpipe, or trachea, when a person swallows. The epiglottis prevents aspiration, the accidental transportation of food or liquid down the windpipe and into the lungs.

When H. influenza or other diseases cause epiglottitis, the epiglottis becomes so inflamed that it blocks the windpipe. Epiglottis symptoms are more common in young children because their windpipes are narrower than those of older people and, therefore, succumb more easily to blockage.

Causes of Epiglottitis

H. influenza is the most common cause of epiglottitis. However, the HIB vaccine has significantly reduced the incidence of H. influenza infections. In addition to H. influenza, a number of other infections can trigger epiglottitis, including:

  • candida albicans
  • haemophilus parainfluenza
  • klebsiella pneumoniae
  • neisseria meningitidis
  • staphylococcus aureus
  • streptococcus A, B, and C
  • streptococcus pneumoniae
  • varicella roster.

Despite use of the HIB vaccine, H. influenza remains the most common cause of epiglottitis, mostly in infants who have not received the HIB vaccine.

Physical injury to the epiglottis can also cause epiglottitis. Physical causes include swallowing foreign objects and ingesting caustic substances.

Symptoms of Epiglottitis

Epiglottitis caused by H. influenza infection begins with a sore throat and fever. The throat feels increasingly sore as the epiglottis becomes more inflamed. As the infection settles in, the child may develop stridor. Stridor is a harsh, high-pitched, raspy sound heard during breathing.

About 80 percent of children with epiglottitis will drool. Drooling occurs when the epiglottis is so inflamed that the child cannot swallow saliva.

Children old enough to sit unassisted may adopt a characteristic known as the sniffing position. The child sits up with the neck extended forward to ease breathing. Often, children in the sniffing position look extremely anxious.

Other epiglottitis symptoms include:

  • chills
  • cyanosis (a bluing of the skin, mouth and/or fingernails due to lack of oxygenated blood to these areas)
  • fever
  • hoarseness
  • refusal to lie down (sitting up eases breathing)
  • shaking.

If you notice that your child has stridor, is starting to drool or prefers the sniffing position, seek immediate medical attention. Epiglottitis progresses very quickly and requires professional treatment.

When caring for a child that is experiencing these symptoms, keep in mind that you shouldn’t:

  • attempt to feed the child (Food and water may induce vomiting, which can further block the already inflamed windpipe.)
  • attempt to examine the child’s throat or mouth for signs of inflammation or blockage (Doing so may trigger spasms that completely close off the windpipe. If this occurs, epiglottitis can kill within minutes.)
  • force the child to lie down, which often worsens epiglottitis symptoms.

Epiglottitis Treatments

Doctors can diagnose epiglottitis after performing a routine exam. If a medical examination reveals epiglottitis, the child will be anesthetized for intubation, the insertion of a breathing tube through the nose and into the trachea.

Emergency epiglottitis treatment may also call for a tracheostomy, a procedure in which a breathing tube is inserted through a surgical incision in the neck. However, tracheostomy is not a common treatment for epiglottitis.

Because the H. influenza is a form of bacterial, taking antibiotics is an effective method of treating epiglottitis. Humidified oxygen will also be administered to ease breathing.

What Parents Should Know

Epiglottitis can often take parents by surprise. What seemed to be a simple sore throat rapidly develops into a life-threatening condition. When distinguishing between a common sore throat and epiglottitis, remember that stridor, drool and the sniffing position indicate a more serious problem. Any of these symptoms warrants medical intervention.

Preventing Epiglottitis: The HIB Vaccine

The HIB vaccine is the best defense against both H. influenza and epiglottitis. Infants receive the HIB vaccine at two months, four months and again at six months of age. An HIB vaccine booster shot is also given between 12 and 15 months.

The HIB vaccine protects only against H. influenza. To reduce the risk of other epiglottitis-causing diseases, frequent hand washing remains the best defense. Children at high risk of epiglottitis should also be isolated from anyone exhibiting symptoms of a sore throat or the common cold.

Resources

eMedicine Health (updated September 20, 2005). Epiglottits. Retrieved September 18, 2007 from the eMedicine Health Web site: http://www.emedicinehealth.com/epiglottitis/article_em.htm.

Mayo Clinic (updated October 4, 2006).Epiglottitis. Retrieved September 18, 2007 from the Mayo Clinic Web site: http://www.mayoclinic.com/health/epiglottitis/DS00529.