Anterior acute bleeding from the nostril or nasal cavity accounts for greater than 90% of epistaxis in children. Posterior bleeding into the nasopharynx and mouth is more difficult to assess and likelier to lead to hemodynamic instability.
Up to one-third of children with recurrent bleeding have a coagulopathy.
Direct pressure via pinching the nostrils for 5 to 10 minutes is the first-line treatment.
Topical lidocaine, silver nitrate sticks, topical oxymetazoline, anterior packing, and other vasoconstrictive and hemostatic tactics may be used.
Posterior epistaxes require referral to an otolaryngologist because they are more difficult to control.