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Management of epistaxis in children

Anna H Messner, MD
Section Editors
Anne M Stack, 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. 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 [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".)


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".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 21, 2016.
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