Epistaxis in children is common and mainly due to enlarged vessels in Little\u2019s area at the anterior septum.
Most bleeds are short lasting and controlled by first aid measures. These consist of pressure to the anterior nose (not the bony part) with the head leaning forward to avoid swallowing of blood followed by emesis.
Management has to be tailored to the urgency of the situation.
Most childhood epistaxis is readily controlled and merits outpatient referral only, very occasionally ongoing severe epistaxis will have to be referred to Emergency Department urgently.<\/p>\n\n\n\n
1. Pinch soft anterior part of nose for up to 20 minutes
2. Lean forward<\/p>\n\n\n\n
3. If actively bleeding in GP practice apply vasoconstrictor (co-phenylcaine or otrivine)<\/p>\n\n\n\n
Is the bleeding acute and does not stop despite correct first aid measures<\/p>\n\n\n\n
1. Duration, predisposing factors, history of injury
2. Determine whether bleeding is unilateral or bilateral
3. How often does bleeding occur
4. How long does it last
5. Any signs of anaemia
6. Medications \u2013 NSAIDS, Aspirin, Warfarin, other anticoagulants, others (rare in children)
7. Family history of bleeding disorder
8. Past medical history \u2013 coagulopathy, platelet disorder or hypertension.
If suspecting blood dyscrasia
o Thorough history (including bruising, bleeding)
o Family history<\/p>\n\n\n\n
ED<\/strong> If child under 2 refer to medical paediatrics\/haematology as in this age group there is more likely to be an underlying bleeding problem or child protection issue.<\/p>\n<\/div><\/div>\n\n\n\n Prolonged course of Naseptin cream for 6 weeks settles most paediatric epistaxis Cautery using 75% silver nitrate sticks if able to provide in community (avoid simultaneous bilateral cautery performing treatment to each side at an interval of 4-6 weeks in children with bilateral epistaxis to avoid septal perforation. NICE guidance on epistaxis<\/a> When considering cauterization please be aware that this is essentially a chemical burn and so it can be painful. Local anaesthetic is very important.<\/p>\n<\/div><\/div>\n\n\n\n Nice guidance on epistaxis<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" Introduction Epistaxis in children is common and mainly due to enlarged vessels in Little’s area at the anterior septum.Most bleeds are short lasting and controlled by first aid measures. These consist of pressure to the anterior nose (not the bony part) with the head leaning forward to avoid swallowing of blood followed by emesis.Management has<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4246,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[169],"class_list":["post-3913","page","type-page","status-publish","hentry","category-epistaxispaeds"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" Epistaxis (Paeds)<\/a>","rttpg_excerpt":"Introduction Epistaxis in children is common and mainly due to enlarged vessels in Little’s area at the anterior septum.Most bleeds are short lasting and controlled by first aid measures. These consist of pressure to the anterior nose (not the bony part) with the head leaning forward to avoid swallowing of blood followed by emesis.Management has","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3913"}],"version-history":[{"count":3,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3913\/revisions"}],"predecessor-version":[{"id":9947,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3913\/revisions\/9947"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4246"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3913"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
If episode of epistaxis not controlled with first aid and still bleeding after 20 minutes of compression<\/p>\n\n\n\n
ENT<\/strong>
If recurrent epistaxis not improved with above management refer to RHCYP for routine review in clinic.
Significant pain\/obstruction refer as urgent<\/p>\n\n\n\n
Paediatric Haematology<\/strong>
Known bleeding disorder \u2013 refer direct to paediatric haematology<\/p>\n\n\n\n
Medical paediatrics or haematology<\/strong><\/p>\n\n\n\n
Naseptin contains peanut oil<\/strong>, so check for allergy
Bactroban or Vaseline can be used in case of peanut allergy, but are not as effective<\/p>\n\n\n\n
<\/p>\n\n\n\n