This pre-referral guideline covers Epistaxis in children from 1-16 years of age.

Initial work-up

• History and physical examination
  • Rule out allergic rhinitis.
• If suspecting  blood dyscrasia
  • Through history (i.e. bruising, bleeding).
  • Family history.
• Blood tests - (PT, APTT) if indicated by history

Pre-referral treatment

• Trial of antibiotic/steroid ointment to anterior septum 2x a day for 2 weeks
• Observation of side
• Acute bleeding usually settles with local pressure to the lower nasal septum

When to refer

• Not responding to conservative management i.e. no nose picking , strong nose blowing, application of topical nasal steroid
• Epistaxis that is severe or occurs frequently
• Attach blood tests results if done

Resources

Kids Connect (RCH Primary Care Liaison)

Kids Health Info (Parent factsheets online)

  Contact information                 

References

Paediatric Handbook(2009)Ear, Nose and Throat Conditions, Chapter 21 (pp312-324);Robert Berkowitz and Michael Marks;Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia