Epistaxis, or bleeding from the nose, is a common complaint. It is rarely life threatening but may cause significant concern, especially among parents of small children.
Epistaxis in children is most commonly related to minor trauma or injury of the anterior nasal septal vessels of Kiesselbach's plexus. A good history will exclude underlying clotting disorders or any relevant family history of recurrent epistaxis or coagulopathies. It is important to ask about other bleeding or easy bruising issues with the child. Examination should include a flexible fiberoptic sinonasal endoscopy when possible to exclude any other possible bleeding source such as a nasal mass or mucosal lesion. In teen boys with history of more severe bleeding and/or unilateral nasal obstruction, one should seek to exclude juvenile nasopharyngeal angiofibroma (JNA) from the differential diagnosis. Anterior nasal exam will often reveal dried blood or prominent vessels of the anterior nasal septum in cases of simple recurrent epistaxis.
Treatment of recurrent epistaxis may be both acute and preventative. For frequent recurrent episodes of simple epistaxis, most children can be treated in the clinic with anterior nasal septal cautery using silver nitrate following topical treatment with dilute lidocaine and xlyometazoline sprays. For more severe cases, or bleeding that recurs following this type of cautery, some children will benefit from endoscopy and electrocautery of the anterior nasal septum in the operating room. One should take care to avoid too extensive of a cauterization bilaterally, especially with electrocautery, as there may be an increased risk of septal perforation.
Lastly, a preventative regimen should be started including either antibiotic ointment or vaseline applied to the anterior nasal septum bilaterally each day - I recommend nightly before bed. A humidifier at the bedside may also help, particularly in the winter months, as dryness of air may be a factor in recurrent episodes.
C. Lewis Kausel
Austin S Rose
Thank you sir for your useful contributions.
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