Key Points
Anterior acute bleeding from the nostril or nasal cavity accounts for more than 90% of epistaxis in children. Posterior bleeding is uncommon, more difficult to assess, and likelier to lead to hemodynamic instability.
Up to one-third of children with recurrent bleeding have coagulopathy.
Direct pressure via pinching the nostrils for at least 5 minutes is the first-line treatment.
Silver nitrate cauterization, topical oxymetazoline, anterior packing, and other vasoconstrictive and hemostatic tactics may be used.
Posterior and recurrent epistaxis may require referral to an otolaryngologist because they are more difficult to control.
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