The most common cause of recurrent childhood epistaxis is local trauma:
Inflammation of the nose due to viral illnesses or sinusitis is another cause of epistaxis.
Treatment is typically supportive for the epistaxis and appropriate for the
cause of the inflammation. The child described in the vignette has no symptoms
or signs of inflammation. Thus, there is no need to culture the nasal
Coagulopathy is an uncommon cause of epistaxis without other evidence of bleeding problems (eg, easy bruising, free bleeding from other areas of trauma) or a positive family history. However, coagulopathy may increase the severity of epistaxis from other causes. If suspected, a von Willebrand panel, bleeding time, or other testing can be ordered to identify the cause and aid in the treatment of epistaxis. The mass in the posterior nasal passage of the child described in the vignette makes coagulopathy an unlikely cause of the epistaxis.
For recalcitrant cases of epistaxis, evaluation for a subtle coagulopathy, CT scan of the sinuses to rule out tumor or sinusitis, or nasal endoscopy to evaluate the posterior aspect of the nose are appropriate. Although sometimes required in adults, children rarely require vessel ligation to control epistaxis. Unlike in adults, hypertension is an uncommon cause of epistaxis in children. However, hypertension does need to be excluded.
Herman A. Visual diagnosis: a child who has a nosebleed and high blood pressure. Pediatr Rev. 2001;22:104-107
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