Bacterial tracheitis is a potentially fatal acute infectious upper airway obstruction, occurring in children of age 3 months to 5 years, predominantly in fall and winter. A prodrome of coryza, sore throat, cough, and pyrexia of 1 to 3 days is followed by acute onset of stridor and rapidly worsening respiratory distress, which can lead to airway obstruction and respiratory arrest. Patients with bacterial tracheitis are toxic appearing and show little response to inhaled steroids or adrenaline. Visualization of the airways reveals subglottic inflammation, edema of the tracheal mucosa, and copious purulent endotracheal secretions. Staphylococcus aureus is the most common bacterial pathogen followed by Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae nontypeable, Moraxella catarrhalis, and Pseudomonas aeruginosa. Viral coinfection is common with Influenza A, Parainfluenza, RSV, and adenovirus. Differential includes viral croup, epiglottitis, foreign body aspiration, and retropharyngeal abscess. Complications include cardiorespiratory arrest, acute respiratory distress syndrome, hypotension, toxic shock syndrome, renal failure, pneumothorax, pulmonary edema, and subglottic stenosis. White blood cell count is usually elevated or abnormally low. Chest and lateral neck radiographs show subglottic narrowing on posterior-anterior view, a hazy tracheal air column and irregular soft-tissue densities in trachea (indicating purulent exudate), pneumonia, and pulmonary edema.