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Epidemiology and etiology of epistaxis in children

Anna H Messner, MD
Section Editors
Glenn C Isaacson, MD, FAAP
Jonathan I Singer, MD
Deputy Editor
James F Wiley, II, MD, MPH


Epistaxis is common in children. Childhood nosebleeds are rarely severe and seldom require hospital admission [1]. Nonetheless, frequent minor nosebleeds can be both bothersome and alarming for parents and children.

The epidemiology and etiology of epistaxis in children will be reviewed here. The evaluation and management of epistaxis in children are discussed separately. (See "Evaluation of epistaxis in children" and "Management of epistaxis in children".)


There is limited evidence regarding the prevalence of nosebleeds in children. One 1979 study found that 30 percent of children younger than five years and 56 percent of children aged 6 to 10 years had had at least one nosebleed [2]. The incidence of epistaxis declines in adulthood, but approximately one-half of all adults with epistaxis had nosebleeds during childhood [3]. Epistaxis is rare in children younger than two years (approximately 1 per 10,000) and should prompt consideration of trauma (intentional or unintentional) or serious illness (eg, thrombocytopenia) [4-6]. Some pediatric healthcare providers believe that when a young baby bleeds from the nose, or is reported to have had a nosebleed, that child abuse must be considered [7,8].

Epistaxis that occurs in children younger than 10 years usually is mild and originates in the anterior nose, whereas epistaxis that occurs in individuals older than 50 years is more likely to be severe and to originate posteriorly [9].

Data from the National Hospital Ambulatory Medical Care Survey indicate that epistaxis accounted for <1 percent of all emergency department visits between 1992 and 2001 [10]. Overall, there were approximately two emergency department visits for epistaxis per 1000 population annually. The age-related frequency was bimodal with one peak in individuals younger than 10 years (4 per 1000 population) and a second peak in those 70 to 79 years.


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Literature review current through: Jan 2017. | This topic last updated: Wed May 27 00:00:00 GMT+00:00 2015.
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  1. Brown NJ, Berkowitz RG. Epistaxis in healthy children requiring hospital admission. Int J Pediatr Otorhinolaryngol 2004; 68:1181.
  2. Petruson B. Epistaxis in childhood. Rhinology 1979; 17:83.
  3. Beran M, Petruson B. Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors. ORL J Otorhinolaryngol Relat Spec 1986; 48:297.
  4. McIntosh N, Mok JY, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics 2007; 120:1074.
  5. Hey E. Sudden oronasal bleeding in a young child. Acta Paediatr 2008; 97:1327.
  6. Paranjothy S, Fone D, Mann M, et al. The incidence and aetiology of epistaxis in infants: a population-based study. Arch Dis Child 2009; 94:421.
  7. Weindling M. Nose bleeds, child protection and the difficulties faced by paediatricians. Acta Paediatr 2008; 97:1318.
  8. Walton LJ, Davies FC. Nasal bleeding and non-accidental injury in an infant. Arch Dis Child 2010; 95:53.
  9. Bernius M, Perlin D. Pediatric ear, nose, and throat emergencies. Pediatr Clin North Am 2006; 53:195.
  10. Pallin DJ, Chng YM, McKay MP, et al. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med 2005; 46:77.
  11. Danielides V, Kontogiannis N, Bartzokas A, et al. The influence of meteorological factors on the frequency of epistaxis. Clin Otolaryngol Allied Sci 2002; 27:84.
  12. Bray D, Monnery P, Toma AG. Airborne environmental pollutant concentration and hospital epistaxis presentation: a 5-year review. Clin Otolaryngol Allied Sci 2004; 29:655.
  13. Edelstein DR, Khabie N. Epistaxis. In: Primary Pediatric Care, 4th, Hoekelman RA. (Ed), Mosby, St. Louis 2001. p.1058.
  14. Nadel F, Henretig FM. Epistaxis. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2006. p.263.
  15. Ruddy J, Proops DW, Pearman K, Ruddy H. Management of epistaxis in children. Int J Pediatr Otorhinolaryngol 1991; 21:139.
  16. Tunnessen WW. Epistaxis. In: Signs and Symptoms in Pediatrics, 3rd, Lippincott Williams & Wilkins, Philadelphia 1999. p.293.
  17. Manning SC, Culbertson MC. Epistaxis. In: Pediatric Otolaryngology, 4th, Bluestone CD, Casselbrant ML, Stool SE, et al (Eds), Saunders, Philadelphia 2002. p.925.
  18. Guarisco JL, Graham HD 3rd. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J 1989; 68:522, 528.
  19. Mulbury PE. Recurrent epistaxis. Pediatr Rev 1991; 12:213.
  20. Coleman CC Jr. Diagnosis and treatment of congenital arteriovenous fistulas of the head and neck. Am J Surg 1973; 126:557.
  21. Pathak PN. Epistaxis--due to ruptured aneurysm of the internal carotid artery. J Laryngol Otol 1972; 86:395.
  22. Köroglu M, Arat A, Cekirge S, et al. Giant cervical internal carotid artery pseudoaneurysm in a child: endovascular treatment. Neuroradiology 2002; 44:864.
  23. Dai A, Jurges E. The problem with nose bleeds. Emerg Med J 2005; 22:596.
  24. Williams PM, Traquina DN, Wallace RC, Niezgoda JJ. Coil embolization of a ruptured carotid pseudoaneurysm presenting as epistaxis--pediatric otolaryngology: principles and practice. Am J Otolaryngol 2000; 21:38.
  25. Reiber ME, Burkey BB. Intracavernous carotid pseudoaneurysm after blunt trauma: case report and discussion. Head Neck 1994; 16:253.
  26. Wyrick D, Smith SD, Dassinger MS. Traumatic carotid-cavernous fistula presenting as massive epistaxis. J Pediatr Surg 2013; 48:883.
  27. Boscardini L, Zanetta S, Ballardini G, et al. Epistaxis in children under the age of two: possible marker of abuse/neglect? A retrospective study in North-Eastern Piedmont hospitals. Minerva Pediatr 2013; 65:71.
  28. Alvi A, Joyner-Triplett N. Acute epistaxis. How to spot the source and stop the flow. Postgrad Med 1996; 99:83.
  29. Karkos PD, Karagama YG, Manivasagam A, El Badawey MR. Magnetic nasal foreign bodies: a result of fashion mania. Int J Pediatr Otorhinolaryngol 2003; 67:1343.
  30. Kalan A, Tariq M. Foreign bodies in the nasal cavities: a comprehensive review of the aetiology, diagnostic pointers, and therapeutic measures. Postgrad Med J 2000; 76:484.
  31. Waddell AN, Patel SK, Toma AG, Maw AR. Intranasal steroid sprays in the treatment of rhinitis: is one better than another? J Laryngol Otol 2003; 117:843.
  32. Murray AB, Milner RA. Allergic rhinitis and recurrent epistaxis in children. Ann Allergy Asthma Immunol 1995; 74:30.
  33. Whymark AD, Crampsey DP, Fraser L, et al. Childhood epistaxis and nasal colonization with Staphylococcus aureus. Otolaryngol Head Neck Surg 2008; 138:307.
  34. Batra K, Chaudhary N, Motwani G, Rai AK. An unusual case of primary nasal tuberculosis with epistaxis and epilepsy. Ear Nose Throat J 2002; 81:842.
  35. Faridi MM, Aggarwal A, Kumar M, Sarafrazul A. Clinical and biochemical profile of dengue haemorrhagic fever in children in Delhi. Trop Doct 2008; 38:28.
  36. Ahmed S, Arif F, Yahya Y, et al. Dengue fever outbreak in Karachi 2006--a study of profile and outcome of children under 15 years of age. J Pak Med Assoc 2008; 58:4.
  37. Kulkarni MJ, Sarathi V, Bhalla V, et al. Clinico-epidemiological profile of children hospitalized with dengue. Indian J Pediatr 2010; 77:1103.
  38. Gullane PJ, Davidson J, O'Dwyer T, Forte V. Juvenile angiofibroma: a review of the literature and a case series report. Laryngoscope 1992; 102:928.
  39. Neel HB 3rd, Whicker JH, Devine KD, Weiland LH. Juvenile angiofibroma. Review of 120 cases. Am J Surg 1973; 126:547.
  40. Komoroski EM. Nasopharyngeal carcinoma: early warning signs and symptoms. Pediatr Emerg Care 1994; 10:284.
  41. Jafek BW, Nahum AM, Butler RM, Ward PH. Surgical treatment of juvenile nasopharyngeal angiofibroma. Laryngoscope 1973; 83:707.
  42. English GM, Hemenway WG, Cundy RL. Surgical treatment of invasive angiofibroma. Arch Otolaryngol 1972; 96:312.
  43. Bass IS, Haller JO, Berdon WE, et al. Nasopharyngeal carcinoma: clinical and radiographic findings in children. Radiology 1985; 156:651.
  44. Norton KI, Som PM, Shugar JM. Persistent cervical adenitis and nasopharyngeal carcinoma in children. J Comput Tomogr 1987; 11:275.
  45. Roper HP, Essex-Cater A, Marsden HB, et al. Nasopharyngeal carcinoma in children. Pediatr Hematol Oncol 1986; 3:143.
  46. Phillips PP, Gustafson RO, Facer GW. The clinical behavior of inverting papilloma of the nose and paranasal sinuses: report of 112 cases and review of the literature. Laryngoscope 1990; 100:463.
  47. Magit AE. Tumors of the nose, paranasal sinuses, and nasopharynx. In: Pediatric Otalryngology, 4th, Bluestone CD, Casselbrant ML, Stool SE, et al. (Eds), Saunders, Philadelphia 2002. p.1053.
  48. Eavey RD. Inverted papilloma of the nose and paranasal sinuses in childhood and adolescence. Laryngoscope 1985; 95:17.
  49. Sandoval C, Dong S, Visintainer P, et al. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002; 24:47.
  50. Medeiros D, Buchanan GR. Major hemorrhage in children with idiopathic thrombocytopenic purpura: immediate response to therapy and long-term outcome. J Pediatr 1998; 133:334.
  51. Katsanis E, Luke KH, Hsu E, et al. Prevalence and significance of mild bleeding disorders in children with recurrent epistaxis. J Pediatr 1988; 113:73.
  52. Reddy VM, Daniel M, Bright E, et al. Is there an association between blood group O and epistaxis? J Laryngol Otol 2008; 122:366.
  53. Shah RK, Dhingra JK, Shapshay SM. Hereditary hemorrhagic telangiectasia: a review of 76 cases. Laryngoscope 2002; 112:767.
  54. Mei-Zahav M, Letarte M, Faughnan ME, et al. Symptomatic children with hereditary hemorrhagic telangiectasia: a pediatric center experience. Arch Pediatr Adolesc Med 2006; 160:596.
  55. Teich M, Longin E, Dempfle CE, König S. Factor XIII deficiency associated with valproate treatment. Epilepsia 2004; 45:187.
  56. Serdaroglu G, Tütüncüoglu S, Kavakli K, Tekgül H. Coagulation abnormalities and acquired von Willebrand's disease type 1 in children receiving valproic acid. J Child Neurol 2002; 17:41.
  57. Watt BE, Proudfoot AT, Bradberry SM, Vale JA. Anticoagulant rodenticides. Toxicol Rev 2005; 24:259.
  58. Watts RG, Castleberry RP, Sadowski JA. Accidental poisoning with a superwarfarin compound (brodifacoum) in a child. Pediatrics 1990; 86:883.
  59. Orlowski JP, Clough JD, Dyment PG. Wegener's granulomatosis in the pediatric age group. Pediatrics 1978; 61:83.