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Michelle M LeRiger,1,2 Veronica Miler,3 Joseph D Tobias,3 Vidya T Raman,3 Charles A Elmaraghy,4,5 Kris R Jatana4,5 1Division of Pediatric Anesthesiology, Omaha Children’s Hospital & Medical Center, 2Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, 3Department of Anesthesiology and Pain Medicine, 4Department of Pediatric Otolaryngology-Head & Neck Surgery, Nationwide Children’s Hospital, 5Department of Otolaryngology-Head and Neck Surgery, Wexner Medical Center at Ohio State University, Columbus, OH, USA Abstract: Retropharyngeal abscesses in the pediatric population can cause severe respiratory distress. We report a rare case of significant airway obstruction in a 14-month-old patient requiring rapid, emergent tracheotomy after attempts at endotracheal intubation by an experienced airway surgeon were unsuccessful. The patient was diagnosed with streptococcal pharyngitis 9 days prior to presentation to our facility and was being treated with amoxicillin. Prompt diagnosis, communication, and appropriate multidisciplinary airway management can lead to successful outcomes even in these severe cases. Keywords: pharyngitis, retropharyngeal abscess, emergent tracheotomy, pediatric airway obstruction, respiratory distress