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Evaluation of epistaxis in children

Anna H Messner, MD
Section Editors
Jonathan I Singer, MD
Glenn C Isaacson, MD, FAAP
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 evaluation of epistaxis in children will be reviewed here. The epidemiology, etiology, and management of epistaxis in children are discussed separately. (See "Epidemiology and etiology of epistaxis in children" and "Management of epistaxis in children".)


Although nosebleeds in children are rarely life threatening, the initial evaluation should focus upon the respiratory and hemodynamic stability of the patient rather than the bleeding. Normal appearance, vital signs, and respiratory function are evidence that the examiner can safely attend to the presenting complaint. On the other hand, abnormalities in these indices may signal an emergency. Airway intervention and fluid resuscitation are sometimes necessary in massive epistaxis. (See 'Emergency treatment' below.)

The goal of the evaluation is to determine the site and etiology of bleeding. Nosebleeds in children have a variety of etiologies, ranging from self-limited mucosal irritation to life-threatening neoplasms (table 1). Distinguishing between local and systemic causes of bleeding is critical to the institution of timely and appropriate therapy [2]. (See "Epidemiology and etiology of epistaxis in children" and "Management of epistaxis in children".)


Rapid assessment of general appearance, vital signs, airway stability, and mental status are necessary to identify children with respiratory or hemodynamic instability who require airway intervention and/or fluid resuscitation [3,4]. Airway intervention is needed for patients who are spitting or regurgitating blood [5]. (See "Emergency endotracheal intubation in children" and "Hypovolemic shock in children: Initial evaluation and management", section on 'Fluid resuscitation' and "Management of epistaxis in children".)


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Literature review current through: Sep 2016. | This topic last updated: Sep 7, 2016.
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