Current Treatment Options in Pediatrics

, Volume 4, Issue 2, pp 203–210 | Cite as

Epistaxis in Children: Evaluation and Management

  • Colin W. Fuller
  • J. Drew Prosser
Otolaryngology (EM Arjmand and D Sidell, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Otolaryngology


Purpose of review

To review treatment options for patients with both ongoing acute epistaxis and chronic recurring epistaxis.

Recent findings

While a common occurrence, epistaxis can successfully be treated with adequate first aid, without a medical provider in most cases. Despite its common nature, widespread knowledge of appropriate first aid is lacking. Recurrent episodes may require further testing depending on the severity. Although a minority of patients referred to specialists have significant underlying pathology, there is little guidance in the literature to help inform practitioners regarding which patients warrant referral. While treatment options for idiopathic pediatric recurrent epistaxis is not currently an active area of research, investigators are actively pursuing novel treatments for hereditary hemorrhagic telangiectasia and endoscopic surgery for juvenile nasal angiofibroma (two rare causes of recurrent epistaxis).


Epistaxis is a common problem in the pediatric population which can lead to patient and family distress. Knowledge of appropriate treatment pathways is lacking and an area for improvement. Epistaxis that persists despite conventional treatment, or epistaxis in the context of a family history of excessive bleeding or a personal history of other sources of recurrent bleeding, may warrant additional evaluation.


Epistaxis Pediatric epistaxis Recurrent epistaxis Idiopathic epistaxis 


Compliance with Ethical Standards

Conflict of Interest

Colin Fuller declares that he has no conflict of interest.

J. Drew Prosser declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    McIntosh N, Mok JYQ, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120(5):1074–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Petruson B. Epistaxis in childhood. Rhinology. 1979;17:83–90.PubMedGoogle Scholar
  3. 3.
    McGarry GW, Moulton C. The first aid management of epistaxis by accident and emergency department staff. Archives of Emergency Medicine. 1993;10:298–300.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Okafor BC. Epistaxis: a clinical study of 540 cases. Ear Nose Throat J. 1984;63(3):153–9.PubMedGoogle Scholar
  5. 5.
    Higgins TS, Hwang PH, Kingdom TT, Olandi RR, Stammberger H, Han JK. Systematic review of topical vasoconstrictors in endoscopic sinus surgery. Laryngoscope. 2011;121:422–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Vaiman M, Segal S, Eviatar E. Fibrin glue treatment for epistaxis. Rhinology. 2002;40(2):88–91.PubMedGoogle Scholar
  7. 7.
    • Felek SA, Celik H, Islam A, Demirci M. Bilateral simultaneous nasal septal cauterization in children with recurrent epistaxis. Int J Pediatr Otorhinolaryngol 2009: 73:1390–1393. This article shows a low complication rate of bilateral nasal cautery in children.Google Scholar
  8. 8.
    •• Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev 2012: 12(9):CD004461. Review. This is a great review of the published articles dealing with treatments of idiopathic recurrent epistaxis in children.
  9. 9.
    Figueiredo RR, Azevedo AA, Avila Kos AO, Tomita S. Nasal foreign bodies: description of types and complications in 420 cases. Brazilian Journal of Otorhinolaryngology. 2006;72(1):18–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Shapiro NL, Battacharyya N. Staging and survival for sinus cancer in the pediatric population. Int J Pediatr Otorhinolaryngol. 2009;73:1568–71.CrossRefPubMedGoogle Scholar
  11. 11.
    Garofalo P, Pia F, Policarpo M, Tunesi S, Valletti PA. Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches. Journal of Craniofacial Surgery. 2015;26(3):918–821.CrossRefPubMedGoogle Scholar
  12. 12.
    Langdon C, Herman P, Verillaud B, Carrau RL, Prevedello D, Nicolai P, et al. Expanded endoscopic endonasal surgery for advanced stage juvenile angiofibromas: a retrospective multi-center study. Rhinology. 2016;54:239–46.Google Scholar
  13. 13.
    • Halderman AA, Ryan MW, Clark C, Sindwani R, Reh DD, Poetker DM, et al. Medical treatment of epistaxis in hereditary hemorrhagic telangiectasia: an evidence-based review. Int Forum Allergy Rhinol 2018 Feb 2. This is another great review of medical options for treatment of epistaxis associated with HHT.
  14. 14.
    •• Sandoval C, Dong S, Visintainer P, Ozkaynak MF, Somasundaram J. Clinical and laboratory features of 178 children with recurrent epistaxis. Journal of Pediatric Hematology and Oncology 2002: 24(1):47–49. This article describes the laboratory findings in children with recurrent epistaxis.Google Scholar
  15. 15.
    Sidonio RF, Gunawardena S, Shaw PH, Ragni M. Predictors of von Willebrand disease in children. Pediatric Blood Cancer. 2012;58:736–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Pearson BW. Epistaxis: some observations on conservative management. J Laryngol Otol. 1983;8:115–9.Google Scholar
  17. 17.
    Viducich RA, Blanda MP, Gerson LW. Posterior epistaxis: clinical features and acute complications. Annales of Emergency Medicine. 1995;26(5):592–6.CrossRefGoogle Scholar
  18. 18.
    Swords C, Patel A, Smith ME, Williams RJ, Kuhn I, Hopkins C. Surgical and interventional radiological management of adult epistaxis: systematic review. J Laryngol Otol. 2017;131(12):1108–30.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology-Head and Neck SurgeryAugusta University Medical CenterAugustaUSA

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