From the Guidelines
For a child with a nosebleed, the most effective initial treatment is to apply firm sustained compression to the lower third of the nose for 5 minutes or longer, as recommended by the clinical practice guideline 1. This approach is based on observational studies and a preponderance of benefit over harm, with the goal of reducing morbidity, protecting the airway, and improving patient satisfaction. The use of topical treatments, such as vasoconstricting agents like oxymetazoline or phenylephrine, may also be considered, but with caution due to the potential risk of cardiac or other systemic complications 1. Key steps to manage a pediatric nosebleed include:
- Having the child sit upright and lean slightly forward to prevent blood from flowing down the throat
- Applying firm sustained compression to the lower third of the nose for 5 minutes or longer
- Using a cold compress or ice pack wrapped in cloth to the bridge of the nose if necessary
- Keeping the inside of the nose moist with saline nasal spray or petroleum jelly applied gently inside the nostrils twice daily to prevent recurrence
- Humidifying the air in the child's room, especially during dry seasons, and discouraging nose picking and teaching children to blow their nose gently. It is essential to seek medical attention if bleeding persists beyond 20 minutes or is severe, as frequent or severe nosebleeds can indicate underlying issues that require further evaluation 1.
From the Research
Treatment Options for Pediatric Nosebleeds
- Epistaxis, or nosebleeds, can be treated with various methods, including first aid measures such as external pressure and ice packing, and applying topical agents like oxymetazoline, which can stop 65-75% of nosebleeds 2.
- Other treatment options include electrocautery, chemical cauterization, and nasal packing with non-absorbable or absorbable materials 2.
- Endoscopic ligation of arteries and endoscopic cauterization are also effective methods for treating epistaxis, with success rates of 97% and higher 2, 3.
- For intractable cases, embolization can be used as an alternative treatment, with a success rate of 80% 2.
Management of Epistaxis in Outpatient Settings
- Epistaxis can be managed in outpatient settings, with compressive therapy and oxymetazoline nasal spray being useful adjuncts to control anterior epistaxis 4.
- Directive nasal cautery and topical therapy can also be used to control localized bleeding or prominent vessels 4.
- Nasal packing can be used if other methods are unsuccessful, but it is often associated with pain and a risk of aspiration if dislodged 4.
Effectiveness of Oxymetazoline in Treating Epistaxis
- Oxymetazoline has been shown to be effective in treating epistaxis, with 65% of patients being successfully managed with oxymetazoline as their sole therapy 5.
- An additional 18% of patients were managed successfully with silver nitrate cautery in combination with oxymetazoline 5.
- Oxymetazoline has also been shown to be effective in treating posterior epistaxis, with 75% of cases being effectively treated with no recurrent bleeding 6.