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This pre-referral guideline covers Epistaxis in children from 1-16 years of age.

Initial work-up

• History and physical examination
  • Rule out allergic rhinitis.
• If suspectingÌý blood dyscrasia
  • Through history (i.e. bruising, bleeding).
  • Family history.
• Blood tests - (PT, APTT) if indicated by history

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Pre-referral treatment

• Trial of antibiotic/steroid ointment to anterior septum 2x a day for 2 weeks
• Observation of side
• Acute bleeding usually settles with local pressure to the lower nasal septum

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When to refer

• Not responding to conservative management i.e. no nose picking , strong nose blowing, application of topical nasal steroid
• Epistaxis that is severe or occurs frequently
• Attach blood tests results if done

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Resources

Kids ConnectÌý(RCH Primary Care Liaison)

Kids Health Info (Parent factsheets online)

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References

Paediatric Handbook(2009)Ear, Nose and Throat Conditions, Chapter 21 (pp312-324);Robert Berkowitz and Michael Marks;Eighth Edition, Blackwell Publishing. By the staff of the Royal Children's Hospital, Melbourne, Australia

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