In epiglottitis, endotracheal tube sizing is

• A. Larger by 2 sizes.
• B. The same as normal.
• C. Smaller by 1-2 sizes.
• D. Never intubated.

Answer: (C)

Epiglottitis narrows the upper airway due to swelling of the supraglottic structures. Because the airway is edema-filled, a tube that fits a normal pediatric airway may be too large to pass safely and can cause trauma or fail to pass at all. Therefore, you choose an endotracheal tube that is smaller than the usual age-based estimate—typically one to two sizes smaller. This smaller size helps you glide through the swollen tissues with less resistance, allows successful airway access, and reduces the risk of mucosal injury. Once the airway is secured and inflammation settles, you can reassess and consider upsizing if needed.