Management of epistaxis in children
- Anna H Messner, MD
Anna H Messner, MD
- Section Editor — Pediatric Otolaryngology
- Professor of Otolaryngology/Head & Neck Surgery and Pediatrics
- Stanford University
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Glenn C Isaacson, MD, FAAP
Glenn C Isaacson, MD, FAAP
- Section Editor — Pediatric Otolaryngology
- Professor, Department of Otolaryngology, Head and Neck Surgery and Pediatrics
- Lewis Katz School of Medicine at Temple University
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Epistaxis is common in children. Childhood nosebleeds are rarely severe and seldom require hospital admission . 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".)
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 . (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 . (See "Epidemiology and etiology of epistaxis in children" and "Evaluation of epistaxis in children".)
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- EMERGENCY TREATMENT
- INDICATIONS FOR CONSULTATION
- ACUTE MANAGEMENT
- Direct compression
- Other techniques
- - Cautery
- - Matrix sealant
- - Fibrin glue
- - Nasal packing
- Advanced techniques
- Additional evaluation
- Special cases
- - Bleeding disorder
- - Anticoagulated patients
- - Hereditary hemorrhagic telangiectasia
- - Juvenile nasopharyngeal angiofibroma
- Discharge instructions
- - Home management
- PREVENTION OF RECURRENT BENIGN EPISTAXIS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS