Epistaxis management in children

Epistaxis is a common childhood complaint and is normally benign and self-limiting. Epistaxis in children is most commonly caused by minor trauma such as nose picking. Alternative diagnosis to consider include recent URTI, allergic rhinitis, nasal foreign body and more rarely bleeding disorders. Epistaxis is unusual in children under the age of two and alternative diagnosis should be considered. Most bleeding occurs anteriorly from Little’s area.

History:

• Length of bleeding (if > 30 mins despite appropriate 1st aid then consider coagulopathy)
• Side of bleeding
• Periodicity of episodes (how many weeks/ months)
• Frequency of episodes
• Associated nasal discharge (if unilateral consider foreign body)
• History of nasal trauma (old or new)
• Bleeding from other sites Past history of easy bruising/ bleeding problems/ haematological abnormality/malignancy
• Family history of bleeding disorders
• Medications e.g. warfarin, nasal corticosteroids.

ABC approach with resuscitation as appropriate.

See flow diagram below for specific management options.

Age	Estimated or actual Weight (kg)	Maximum number of sprays
1	10	1
2	12	1
3	14	2
4	16	2
5	18	2
6	25	3
7	28	4
8	31	4
9	34	5
10	37	5
11	40	6
12+	43+	Max 8

Age	Formula
0-12 months	Weight (in kg) = (0.5 x age in months) + 4
1-5 years	Weight (in kg) = (2 x age in years) + 8
6-12 years	Weight (in kg) = (3 x age in years) + 7

Instructions for use:                                                                   

Prime spray nozzle after attachment by spraying 3 times before administering to patient. 

For Epistaxis:

Can be sprayed onto a cotton wool ball and applied up nostril or sprayed directly to point of bleeding. 

For Tonsillar bleeding:

Spray directly on to the point of bleeding.