Rare in infancy, common in children older than 2 yr of age

:lock_with_ink_pen: Rare in infancy, common in children older than 2 yr of age.
:lock_with_ink_pen: Incidence decreases after puberty.
:lock_with_ink_pen:The most common site of bleeding is the Kiesselbach plexus, an area in the anterior septum
:lock_with_ink_pen:Thin mucosa in this area, as well as the anterior location,
make it prone to exposure to dry air and trauma.


:point_right:There is often a family history of childhood epistaxis.
:point_right:Susceptibility is increased during respiratory infections and in the winter when dry air irritates the nasal mucosa, resulting in formation of fissures and crusting.
:point_right:Epistaxis can be classified into primary or secondary .

:flags:digital trauma
:flags:foreign bodies
:flags:dry air, and inflammation, including upper respiratory tract infections,sinusitis, and allergic rhinitis (Table below​:point_down::point_down:)
:flags: chronic use of Nasal steroid spray
:flags: significant gastroesophageal reflux rarely present with epistaxis secondary to mucosal inflammation.
:flags: Severe bleeding may be encountered with congenital vascular abnormalities, such as hereditary hemorrhagic telangiectasia ( varicosities, hemangiomas

:flags:The family
history may be positive for abnormal bleeding (epistaxis or other sites);
specific testing for von Willebrand disease is indicated because the
prothrombin time or partial thromboplastin time may be normal
despite having a bleeding disorder.

:flags: in children with thrombocytopenia, deficiency of clotting
factors, particularly von Willebrand disease
:flags: Hypertension, renal failure, or venous congestion.

:point_right::point_right:Recurrent epistaxis despite cauterization is associated with mild coagulation disorders.
:flags:Nasal polyps or other intranasal
growths may be associated with epistaxis.
:flags: May be the initial presenting symptom in juvenile nasal angiofibroma, which occurs in adolescent boys.

:safety_vest:CLINICAL MANIFESTATIONS​:safety_vest:
:squid:Epistaxis usually occurs without warning, with blood flowing slowly
but freely from one nostril or occasionally from both.
:squid:With nasal lesions, bleeding might follow physical exercise
:squid:When bleeding
occurs at night, the blood may be swallowed and become apparent only
when the child vomits or passes blood in the stools.
:squid:Posterior epistaxis
can manifest as anterior nasal bleeding or, if bleeding is copious, the patient might vomit blood as the initial symptom.


:herb:Most nosebleeds stop spontaneously in a few minutes.
:herb:The nares should be compressed
:herb:the child kept as quiet as possible, in an upright position with the head tilted forward to avoid blood trickling back into the throat.
:herb:Cold compresses applied to the nose can also help.
:herb:If these measures do not stop the bleeding​:point_right:local application of a solution of oxymetazoline (Afrin or Neo-Synephrine) (0.25-1%) may be
:herb:If bleeding persists, an anterior nasal pack may need to be
:herb: If bleeding originates in the posterior nasal cavity, combined anterior and posterior packing is necessary.
:herb:After bleeding is under controland if a bleeding site is identified :point_right:its obliteration by cauterywith silver nitrate may prevent further difficulties.
:point_right: Because the septal cartilage derives its nutrition from the overlying mucoperichondrium
:herb:only one side of the septum should be cauterized at a time to reduce the chance of a septal perforation. :herb:During the winter, or in a dry environment, a room humidifier, saline drops, and petrolatum (Vaseline)
applied to the septum can help to prevent epistaxis.
:herb: Antiseptic cream
(e.g., mupirocin) significantly increases the proportion of children who have complete resolution of bleeding at 8 wk compared to no treatment. :herb:Ointments prevent infection, increase moisture, decrease
bleeding, and are commonly used in clinical practice. :herb:However, the combination of silver nitrate cautery and antiseptic nasal cream is superior to antiseptic cream alone.
:herb: Patients with severe epistaxis despite conservative medical measures should be considered for surgical ligation techniques or embolization.
:herb:In patients with severe or repeated epistaxis, blood transfusions may be necessary. :herb:Otolaryngologic evaluation is indicated for these children and for those with
bilateral bleeding or with hemorrhage that does not arise from the Kiesselbach plexus.
:herb:Secondary epistaxis should be managed by identification of the cause, application of appropriate nasal therapy, and
correct systemic medical management
:herb:Hematologic evaluation (for coagulopathy and anemia), along with nasal endoscopy and diagnostic imaging, may be needed to make a definitive diagnosis in cases of
severe recurrent epistaxis. :herb:Replacement of deficient clotting factors may be required for patients who have an underlying hematologic disorder
:herb:Profuse unilateral epistaxis associated with a nasal mass in an adolescent boy
:herb:near puberty might signal a juvenile
nasopharyngeal angiofibroma.
:herb: CT with contrast medium enhancement and MRI are part of the initial evaluation; arteriography, embolization, and extensive surgery may be needed.
:herb:Surgical intervention may also be needed for bleeding from the
internal maxillary artery or other vessels that can cause bleeding in the
posterior nasal cavity.

:flying_disc:The discouragement of nose picking
:flying_disc: attention to proper humidification of the bedroom during dry winter months helps to prevent many nosebleeds.
:flying_disc: Prompt attention to nasal infections and allergies is
beneficial to nasal hygiene.
:flying_disc:Prompt cessation of nasal steroid sprays prevents ongoing bleeding.

:crystal_ball:Nelson 20​:crystal_ball: