In a toddler in acute respiratory distress, which finding raises suspicion for epiglottitis?

Drooling in a toddler experiencing acute respiratory distress raises significant suspicion for epiglottitis. This condition is characterized by inflammation and swelling of the epiglottis, which can lead to difficulty swallowing and a feeling of obstruction in the airway. When the epiglottis swells, it may make it painful or difficult for the child to swallow saliva, resulting in drooling. In addition, toddlers often instinctively try to avoid swallowing because of the pain or discomfort, further contributing to excessive drooling.

The presence of drooling is often associated with a classic triad of symptoms for epiglottitis, which also includes stridor and a preference for leaning forward (tripod positioning). In contrast, other findings listed—such as rash, hoarseness, and rapid breathing—are associated with different conditions or may not be as specific for epiglottitis. For instance, rash may suggest an allergic or infectious process, while hoarseness can be due to upper airway irritation, and rapid breathing might indicate respiratory distress from causes other than epiglottitis. Therefore, drooling stands out as an indicative sign for this serious condition.