Childhood epistaxis

Nosebleeds are very common in children, affecting 30% of children aged 0–5, 56% of those aged 6–10 and 64% of those aged 11–15. In most cases, the problem is simple to diagnose and treat. • Any history of unexpected bruising or bleeding from other sites (e.g. bleeding gums)? It is rare for severe haematological disorders such as leukaemia to present with epistaxis as the sole complaint, but a history of excessive bleeding after minor trauma should raise the possibility of a haematological disorder such as von Willebrand disease. Studies suggest as many as 5–10% of children with recurrent nosebleeds despite treatment may have undiagnosed von Willebrand disease. • Is the problem unilateral or bilateral? Are there any associated nasal symptoms such as blockage, discharge or pain? Tunours are rare, but unilateral symptoms in association with facial swelling, pain and obstruction are suspicious. The head and neck is the commonest site of rhabdomyosarcoma in children. Juvenile nasal angiofibroma presents with nasal obstruction and epistaxis in adolescent boys. • Is there any history of trauma? • Is the child on medications? Anticoagulant use in children is rare, except in those with congenital heart disease. • Does the child have any allergies? It is important to ask about allergy to peanuts if you plan to prescribe an antiseptic cream such as Naseptin, which is made from peanut oil.