UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Management of epistaxis in children

Author
Anna H Messner, MD
Section Editors
Anne M Stack, MD
Glenn C Isaacson, MD, FAAP
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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. Most epistaxis in children is minor and is easily managed with direct compression of the nasal alae for 5 to 10 minutes. For more significant or recurrent epistaxis other techniques might include vasoconstrictor nose drops, cautery with 75 percent silver nitrate, topical sealants or glue, nasal packing, or balloon catheters. Children with refractory epistaxis or underlying local or systemic factors (eg, nasal tumor or bleeding disorder) that predispose to epistaxis require an individualized approach to management and specialty consultation.

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

EMERGENCY TREATMENT

Most children with epistaxis have spontaneous anterior nasal bleeding without airway compromise or hemodynamic instability. Rapid assessment of general appearance, vital signs, airway stability, and mental status are still necessary to identify children who require airway intervention and/or fluid resuscitation [2,3]. Airway intervention may be needed for patients who are spitting or regurgitating blood and in those with hemorrhagic shock [4]. (See "Emergency endotracheal intubation in children" and "Hypovolemic shock in children: Initial evaluation and management", section on 'Fluid resuscitation'.)

In patients with marked nasal hemorrhage, rapid assessment and stabilization is followed immediately by attempts to identify the source of bleeding and initiation of measures to control it, usually in consultation with otolaryngology [2,3]. Blood factors or platelets should be administered to patients who have bleeding disorders that can be treated with such products. The remainder of the evaluation is undertaken after the patient is stabilized. (See "Evaluation of epistaxis in children".)

INDICATIONS FOR CONSULTATION

Most episodes of epistaxis resolve with compression of the nasal alae for 5 to 10 minutes and do not require specialty care. Referral to or consultation with an otolaryngologist or other specialist is indicated for patients with severe epistaxis, troublesome recurrent epistaxis, or local abnormalities, such as tumors (image 1), polyps, or telangiectasias [2]. (See "Epidemiology and etiology of epistaxis in children" and "Evaluation of epistaxis in children".)

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Fri Oct 21 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Brown NJ, Berkowitz RG. Epistaxis in healthy children requiring hospital admission. Int J Pediatr Otorhinolaryngol 2004; 68:1181.
  2. Nadel F, Henretig FM. Epistaxis. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM (Eds), Lippicott Williams & Wilkins, Philadelphia 2006. p.263.
  3. Alvi A, Joyner-Triplett N. Acute epistaxis. How to spot the source and stop the flow. Postgrad Med 1996; 99:83.
  4. Bernius M, Perlin D. Pediatric ear, nose, and throat emergencies. Pediatr Clin North Am 2006; 53:195.
  5. Guarisco JL, Graham HD 3rd. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J 1989; 68:522, 528.
  6. Higgins TS, Hwang PH, Kingdom TT, et al. Systematic review of topical vasoconstrictors in endoscopic sinus surgery. Laryngoscope 2011; 121:422.
  7. Groudine SB, Hollinger I, Jones J, DeBouno BA. New York State guidelines on the topical use of phenylephrine in the operating room. The Phenylephrine Advisory Committee. Anesthesiology 2000; 92:859.
  8. Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician 2005; 71:305.
  9. Calder N, Kang S, Fraser L, et al. A double-blind randomized controlled trial of management of recurrent nosebleeds in children. Otolaryngol Head Neck Surg 2009; 140:670.
  10. Makura ZG, Porter GC, McCormick MS. Paediatric epistaxis: Alder Hey experience. J Laryngol Otol 2002; 116:903.
  11. McGarry G. Nosebleeds in children. Clin Evid 2005; :399.
  12. Douglas R, Wormald PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007; 15:180.
  13. Vaiman M, Segal S, Eviatar E. Fibrin glue treatment for epistaxis. Rhinology 2002; 40:88.
  14. Farnan TB, Gallagher G, Scally CM. A novel treatment for patients with hereditary haemorrhagic telangiectasia. J Laryngol Otol 2002; 116:849.
  15. Vaiman M, Martinovich U, Eviatar E, et al. Fibrin glue in initial treatment of epistaxis in hereditary haemorrhagic telangiectasia (Rendu-Osler-Weber disease). Blood Coagul Fibrinolysis 2004; 15:359.
  16. Walshe P. The use of fibrin glue to arrest epistaxis in the presence of a coagulopathy. Laryngoscope 2002; 112:1126.
  17. Mulbury PE. Recurrent epistaxis. Pediatr Rev 1991; 12:213.
  18. Edelstein DR, Khabie N. Epistaxis. In: Primary Pediatric Care, 4th ed, Hoekelman RA (Ed), Mosby, St. Louis 2001. p.1058.
  19. Manning SC, Culbertson MC. Epistaxis. In: Pediatric Otolaryngology, 4th, Bluestone CD, Casselbrant ML, Stool SE, et al (Eds), Saunders, Philadelphia 2002. p.925.
  20. Weber R, Keerl R, Hochapfel F, et al. Packing in endonasal surgery. Am J Otolaryngol 2001; 22:306.
  21. Abram AC, Bellian KT, Giles WJ, Gross CW. Toxic shock syndrome after functional endonasal sinus surgery: an all or none phenomenon? Laryngoscope 1994; 104:927.
  22. de Vries N, van der Baan S. Toxic shock syndrome after nasal surgery: is prevention possible? A case report and review of the literature. Rhinology 1989; 27:125.
  23. Jacobson JA, Stevens MH, Kasworm EM. Evaluation of single-dose cefazolin prophylaxis for toxic shock syndrome. Arch Otolaryngol Head Neck Surg 1988; 114:326.
  24. Graham DR, O'Brien M, Hayes JM, Raab MG. Postoperative toxic shock syndrome. Clin Infect Dis 1995; 20:895.
  25. Goldman JL, Winstead W, Ganzel TM. Embolization as the definitive treatment of epistaxis in the pediatric patient. Ear Nose Throat J 1995; 74:490.
  26. Christensen NP, Smith DS, Barnwell SL, Wax MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 2005; 133:748.
  27. Teymoortash A, Sesterhenn A, Kress R, et al. Efficacy of ice packs in the management of epistaxis. Clin Otolaryngol Allied Sci 2003; 28:545.
  28. Glynn F, Amin M, Sheahan P, Mc Shane D. Prospective double blind randomized clinical trial comparing 75% versus 95% silver nitrate cauterization in the management of idiopathic childhood epistaxis. Int J Pediatr Otorhinolaryngol 2011; 75:81.
  29. Johnson N, Faria J, Behar P. A Comparison of Bipolar Electrocautery and Chemical Cautery for Control of Pediatric Recurrent Anterior Epistaxis. Otolaryngol Head Neck Surg 2015; 153:851.
  30. Robertson S, Kubba H. Long-term effectiveness of antiseptic cream for recurrent epistaxis in childhood: five-year follow up of a randomised, controlled trial. J Laryngol Otol 2008; 122:1084.
  31. Loughran S, Spinou E, Clement WA, et al. A prospective, single-blind, randomized controlled trial of petroleum jelly/Vaseline for recurrent paediatric epistaxis. Clin Otolaryngol Allied Sci 2004; 29:266.
  32. Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev 2012; :CD004461.
  33. Kubba H, MacAndie C, Botma M, et al. A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood. Clin Otolaryngol Allied Sci 2001; 26:465.