Epiglottitis is a bacterial infection that causes the epiglottis, the small flap of tissue that covers the windpipe when we swallow, to swell. Because the swelling can close off the airway completely, epiglottitis is always a medical emergency. It was once most common in children aged one to four, but widespread Hib vaccination has made it rare in children, and today a large share of cases occur in adults. The first aid aim is simple: recognise it, avoid making it worse, and get an ambulance on the way.
Warning Signs of Epiglottitis
- A very sore throat with pain on swallowing
- Drooling because swallowing is too painful
- A muffled or “hot potato” voice
- A high temperature, flushed skin and a look of anxiety or illness
- Noisy, harsh breathing when breathing in (stridor), sometimes with the chest pulling inwards
- Sitting upright and leaning forward with the chin out, which is the position that keeps the airway most open
Unlike croup, epiglottitis often comes on quickly over hours, and the typical barking cough may be absent.
Epiglottitis First Aid: What to Do While Waiting
- Call the emergency number immediately. Say that you suspect a swollen airway so the crew can prepare.
- Let the person stay in the position they choose. Usually this is sitting upright and leaning forward. For a small child, let them stay on a parent’s lap. Do not lay them flat.
- Keep them calm. Speak quietly and avoid anything that increases distress, because crying and struggling can tighten the airway.
- Do not examine the throat. Looking in with a spoon or torch, or pressing on the tongue, can trigger sudden complete blockage.
- Give nothing by mouth. No food, drink or medicines.
- Monitor and be ready. Watch breathing, colour and responsiveness. If the person collapses or stops breathing, lay them down, open the airway and start CPR using the steps in our DRABC primary survey guide.
- Give oxygen only if trained and equipment is available, as directed by local protocol.
Why Epiglottitis Is So Dangerous
The swollen epiglottis can fold over the entrance to the windpipe. In small children the airway is already narrow, so even a small amount of swelling causes a large drop in airflow. The condition can worsen suddenly, which is why hospital teams treat it as an airway emergency and secure the airway first, usually in an operating theatre or intensive care setting with experienced staff, before giving intravenous antibiotics.
Epiglottitis Compared With Croup and Choking
| Feature | Epiglottitis | Croup | Choking |
|---|---|---|---|
| Onset | Hours | Days, worse at night | Sudden |
| Cough | Usually absent | Barking | Weak or none |
| Drooling | Common | Rare | Possible |
| Fever | High | Mild | None |
| Usual first aid | Upright, calm, call ambulance | Calm, fluids, medical review | Back blows and thrusts |
If you are unsure which one you are dealing with, treat it as the most serious possibility and call for help. As the workbooks used in many first aid courses point out, even doctors can find croup and epiglottitis hard to tell apart at first glance.
Preventing Epiglottitis
Make sure children complete the Hib vaccination schedule, and keep adult vaccinations such as pneumococcal vaccines up to date where recommended. Anyone with a rapidly worsening sore throat, trouble swallowing and a changing voice should seek urgent medical care rather than waiting to see if it passes.
Frequently Asked Questions
Can adults get epiglottitis?
Yes. Since the Hib vaccine became routine, adults make up a large proportion of cases, often with a severe sore throat and a muffled voice.
Is epiglottitis contagious?
The bacteria that cause it can spread through droplets, but most contacts do not develop epiglottitis. Doctors may offer preventive treatment to close contacts in some situations.
Should I try to look at the throat?
No. Examining the throat can provoke a sudden complete blockage. Leave that to hospital staff who can secure the airway.
References and Further Reading
Last updated: October 2026
Prepared by: EHS Guidelines Editorial Team
This article is general educational information and is not a substitute for accredited first aid training or professional medical care. In an emergency, call your local emergency number immediately. Emergency numbers, medicines and protocols differ between countries, so follow local guidance.
Related Guides
- Croup in Children: Signs, Home Care and When to Call an Ambulance
- Infant Choking First Aid: Back Blows and Chest Thrusts for Babies and Children
- Airway Management: How to Open, Clear and Protect an Airway
- Vital Signs Observations: Pulse, Breathing, Conscious State and Skin
- CPR for Infants and Children: Technique and Key Differences from Adults
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