The case records of 31 children presenting to Christchurch Hospital with acute epiglottitis over the last 15 years have been reviewed. There has been a significant increase in incidence over this period (p less than 0.05). Despite generally classical presenting features the disease was recognised in only 26% of children when seen by general practitioners prior to admission. The increasing problem of ampicillin resistance to Haemophilus influenzae type b locally has resulted in a change in first line antibiotic therapy in recent years. Changes have also occurred in methods of airway management with elective nasotracheal intubation now the usual procedure.