Patients less than year old with deep space neck infections may present with little more than fever and fussiness Initial antibiotic choices for patients with deep space neck infections include ampicillin-sulbactam or clindamycin Clindamycin has superior MRSA coverage but has a less palatable transition to oral therapy Current Evidence A retropharyngeal abscess occurs in the potential space between the prevertebral fascia and the posterior pharyngeal wall This retropharyngeal space contains two chains of lymph nodes that are prominent in younger children, but often disappear by puberty These nodes can become enlarged and necrotic in the setting of upper respiratory tract infections, and subsequently become infected The usual pathogens are group A streptococci, anaerobic organisms, and occasionally S aureus These infections occur most often in children younger than years A lateral pharyngeal (or parapharyngeal) abscess occurs in the deep soft tissue space of the neck as well, but not in the midline, and is less common than a retropharyngeal infection in the younger patient population Clinical Considerations Clinical Recognition Patients with deep space neck infections often present with fever and appear quite ill Patients presenting early in the course of illness may be diagnosed with simple pharyngitis; progression of the abscess manifests with sore throat, difficulty swallowing, stiff neck, muffled voice, and, late in the course, rarely stridor Often, there is a history of a preceding viral upper respiratory infection Triage Considerations Patients with deep space neck infections are often ill appearing Evidence of upper airway obstruction such as tripod positioning, difficulty with handling secretions, or stridor should be immediately evaluated by a provider If patients are severely ill with respiratory distress, an otolaryngology evaluation should be obtained promptly Initial Assessment Particular attention should be paid to signs of upper airway obstruction on physical examination Patients may put themselves in a position of comfort Those with more advanced disease may show signs of severe distress such as