Epistaxis management in children, paediatrics (490)

Objectives

Guidance for the assessment and management of children presenting with epistaxis.

Scope

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Audience

Emergency department medical and nursing staff.

Introduction

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.

Assessment

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.

Management

ABC approach with resuscitation as appropriate.

See flow diagram below for specific management options.

Dosing Guidance for topical application of Lidocaine (5%) & Phenylephrine (0.5%) spray

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.

Last reviewed: 09/07/2025

Next review date: 31/07/2028

Author(s): Shona Leighton, Steve Foster.

Version: 3

Author email(s): steven.foster@ggc.scot.nhs.uk.

Approved By: Paediatric Emergency Department Guidelines Group

Document Id: 490