• 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.

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