Bleeding into the retropharyngeal region in children is an unusual cause of acute upper airway obstruction. Even in the absence of known risk factors or aetiology, this rare entity should be considered as one of the differential diagnoses of retropharyngeal swellings in children. Prompt surgical intervention is required whenever rapid progression to airway obstruction is observed. In this case report, we present an 18-month-old girl previously managed as upper respiratory tract infection, who presented with progressive dysphagia, drooling and eventually airway obstruction with stridor and respiratory distress. Conservative prolonged airway protection by intubation or tracheostomy was averted by an emergency incision and drainage of the haematoma. There was complete resolution by the second week and no recurrence reported at follow-up 18 months later.