Epiglottitis is a potentially life-threatening disease and is largely preventable by vaccination against Haemophilus influenzae type b (Hib). Little is known, however, about the epidemiology of childhood epiglottitis in Asian countries, including Japan. Using a nationwide inpatient database, this study aimed to determine the burden of childhood epiglottitis before the introduction of Hib vaccine into Japan. The study period was between July and December in 2007 and 2008, when Hib vaccine was not available. We found 102 cases with epiglottitis among children a parts per thousand currency sign5 years old. The annual incidence of epiglottitis in children a parts per thousand currency sign5 years old was estimated to be 3.2 per 100,000 population per year. Among the 102 patients, 31 (30.4 %) required respiratory support, including two cases with tracheotomy and one fatal case. Our study demonstrated the substantial burden of epiglottitis among Japanese children, highlighting that a routine Hib vaccination program is essential.