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Analgesia & Sedation
Epistaxis in children is usually from Little's area (see diagram), which is on the septal wall anteriorly. The bleeding is usually venous, is of brief duration and is often recurrent.
The two most important factors in childhood epistaxis are:
Rarer causes include foreign bodies, nasal polyps, bleeding diatheses, vascular malformations, and nasopharyngeal tumors.
Consider underlying diagnosis / cause if:
If signs of shock refer to Resuscitation
Try simple measures first to stop the bleeding:
If this stops the bleeding, the child can be discharged. See discharge information
If persistent bleeding:
Consult a senior doctor if cautery is required.
Do not attempt under the age of four years as it is unlikely the child will cooperate.
Cautery procedure video
If these measures stop the bleeding, see discharge information below.
If these measures fail, nasal packing may be required.
If site of bleeding known, insert unilateral anterior nasal pack.
Bilateral anterior packing or any posterior packing should not be attempted without ENT consultation.
The easiest form of anterior packing is to use a prefabricated nasal tampon e.g. Merocel®.
If unilateral anterior packing stops the bleeding, discharge home and review in 48 hours. Moisten with saline prior to removal and provide discharge information.
Discuss with ENT if:
Children requiring care beyond the level of comfort of the local healthcare facility.
For emergency advice
and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal
Emergency Retrieval (PIPER) Service: 1300 137 650.
Bleeding has stopped.
Parents provided education on ongoing management and management of recurrence (see below).
* There is a risk of chemical pneumonitis if petroleum based gel is
inhaled - long term use should be avoided.
Last Updated March 2019