Deep neck space infections are uncommon but potentially life-threatening conditions with variable presentation in children without clear indications for medical versus surgical management. This study aimed to identify predictors of surgical intervention.

A retrospective review was conducted of paediatric patients with deep neck space infections at a tertiary centre between 2014 and 2024. Patients were grouped by treatment approach: medical therapy, primary surgery or surgery following medical therapy. Clinical, radiological and outcome variables were analysed to identify predictors of surgical intervention.

Ninety-two patients were included: 51.1 per cent were managed successfully with antibiotics alone, and 48.9 per cent required surgery initially or after medical trial. Independent predictors of surgical intervention included younger age, fever (< 38.0° Celsius) at presentation, computed tomography confirmed abscess and cross-sectional area greater than 3.00 cm2.

Most deep neck infections respond to medical management, though younger age, fever and larger abscess size should prompt consideration for surgical consideration.