Which of the following symptoms is NOT typically seen in acute epiglottitis?

In acute epiglottitis, the hallmark symptoms typically include stridor, changes in voice, and difficulty speaking due to airway obstruction caused by inflammation of the epiglottis. Stridor is a high-pitched wheezing sound that occurs when there is an obstruction in the upper airway, which can happen because of the swelling associated with epiglottitis.

Changes in voice occur due to the inflammation affecting the structures around the larynx and surrounding areas, and difficulty speaking is a direct result of the compromised airway and potential distress or discomfort in making sounds.

Marked lethargy, however, is not a characteristic symptom specifically associated with acute epiglottitis. While a child may appear ill or have a general sense of malaise, the key symptoms being observed typically revolve around respiratory difficulty and vocal alteration rather than significant lethargy. Lethargy might be seen in other conditions or as a general response to severe illness, but it is not a specific symptom of acute epiglottitis itself. Thus, its absence or the incorrect assumption of its prominence in this context makes it the symptom that is not typically associated with this condition.