Epistaxis in children

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Target exams

Red flags

• A child whose nosebleed does not stop after 15 to 20 minutes of firm, correctly applied continuous pressure on the soft part of the nose, or bleeds briskly from both nares with swallowed blood — a posterior or severe bleed needing topical vasoconstriction, cautery or packing rather than a longer trial of first aid.
• Recurrent epistaxis with bruising, petechiae, gum bleeding, menorrhagia or a family history of bleeding — an underlying bleeding disorder such as von Willebrand disease, a platelet disorder or leukaemia; send a full blood count and coagulation screen before any cautery.
• Unilateral epistaxis with nasal obstruction in an adolescent boy — juvenile nasopharyngeal angiofibroma, a highly vascular tumour; never biopsy in clinic, image first and refer to ENT for embolisation and resection.
• A child tilted backward during a nosebleed — swallowed blood causing vomiting and a small but real aspiration risk; correct first aid is sitting upright and leaning forward.

Life stages

Care settings

Clinical exam formats

Board mappings

• General Paediatrics and ENT: epistaxis in children — definition, the predominance of anterior Little's area bleeds, the common precipitants and the red flags that demand urgent assessment.
• First aid and preventive care: the correct first-aid technique and the safety-net advice that reduces recurrent bleeding.
• Renewed curriculum — ENT and haematology: the Kiesselbach's plexus and sphenopalatine artery anatomy, the stepwise escalation from cautery to packing, and the work-up of suspected bleeding disorder.
• Public health and systems: first-aid education for families and schools, and the disproportionate burden of recurrent epistaxis in remote and disadvantaged communities.
• General Paediatrics: recognition of the benign anterior majority versus the posterior, recurrent or systemic bleeds, with the work-up of the recurrent case.
• Emergency and acute care: first aid, cautery and packing decisions, and the disposition and safety-net for the discharged child.
• Long Case / Structured discussion: a child with recurrent epistaxis — cause, investigation, stepwise management, complications and the bleeding-disorder and tumour red flags.
• Communication station: teaching a parent correct first-aid technique and explaining why leaning forward and pinching the soft nose works.
• Level 2 / 3 — ENT and haematology: anterior and posterior epistaxis, first aid, cautery and the recognition of underlying bleeding disorder.
• Health promotion: first-aid education for families and the prevention of recurrent epistaxis.
• Foundation of Practice (FOP): the causes and first aid of childhood epistaxis and the differential of recurrent bleeding.
• Applied Knowledge in Practice (AKP): stepwise management, the cautery decision and the bleeding-disorder and juvenile-nasopharyngeal-angiofibroma red flags.
• History-taking and management: the child with recurrent nosebleeds, the family history of bleeding and the management plan.
• Communication: teaching correct first-aid technique and safety-net advice to a family.
• General Pediatrics Content Outline: epistaxis — causes, first aid, cautery, packing and the bleeding-disorder work-up.
• Otolaryngology and Hematology: anterior and posterior epistaxis, recurrent disease management and recognition of systemic causes.
• Patient Care: correct first aid, stepwise evidence-based management of epistaxis and prompt recognition of the severe and systemic causes.
• Systems-Based Practice and Population Health: first-aid education for families and schools, and antibiotic stewardship around nasal packing.
• Medical Knowledge: the Kiesselbach's plexus and sphenopalatine artery anatomy, the cautery and packing techniques, and the pharmacology of topical vasoconstrictors.
• Medical Expert: epistaxis diagnosis, first aid, cautery and packing, and recognition of bleeding disorder and juvenile nasopharyngeal angiofibroma.
• Health Advocate and Collaborator: first-aid education, culturally safe care for Indigenous and remote families, and timely ENT and haematology referral.
• Communicator: teaching correct first-aid technique and safety-net advice to families.