Recurrent epistaxis in children

Abstract

Question A child came to my clinic complaining of recurrent epistaxis with several episodes occurring every year since he was a toddler. The nosebleeds affect both nostrils, often lasting for an extended period of time and occurring in no apparent seasonal pattern. What interventions are safe and effective for recurrent epistaxis in children, and which patients warrant hematologic testing? Answer Epistaxis affects more than half of children by the time they are 10 years old, with 9% of children reported to have recurrent episodes. Most cases are of benign origin and will not require further workup. For those seeking intervention, nasal mucosal hydration, such as emollient application, or humidification resolves up to 65% of cases, and many novel interventions have shown promise in their respective initial studies. Standardized bleeding questionnaires have demonstrated usefulness in decision making for further coagulation studies, taking into account historical features including frequency, duration, bleeding site, seasonal correlation, and severity.

Incidence and Risk Factors for Antibiotic-associated Diarrhea Among Hospitalized Children

“…All children hospitalized during the 1-year period that fulfilled the inclusion criteria were included in the study. Inclusion criteria for the study were; (1) >1 month and ≤18 years old; (2) receiving antibiotics during hospitalization; (3) having no comorbid diseases such as cystic fibrosis, inflammatory bowel disease, celiac disease, allergic diseases, immunodeficiencies, chronic renal failure, diabetes, intestinal parasites and other chronic diseases that may be associated with increased risk of diarrhea and (4) absence of acute gastroenteritis at initial admission; and no usage of drugs such as probiotics, prebiotics, laxatives, and anti-diarrheal drugs within the previous 2 weeks.…”

“…1 Most guidelines recommend preventing AAD in high-risk patients by using specific strains of probiotics along with antibiotic treatment. 2–4…”

Epistaxis duration predicts bleeding in immune thrombocytopenia: a cohort study

“…The precise incidence is unclear, but it is suggested that as many as three in four children may experience at least one episode of epistaxis at some time. Recurrent epistaxis is seen in 9% of children and it is a common cause of presentation to emergency departments 8–10…”

Simplified management of epistaxis

“…Health care providers frequently treat nosebleeds, and epistaxis has been the subject of many contemporary reviews (Krulewitz & Fix, 2019; Schlosser, 2009; Tunkel et al, 2020; Womack et al, 2018; Yau, 2015; Qureshi 2012). The American Academy of Otolaryngology—Head and Neck Surgery recently published clinical epistaxis guidelines (AAOHNS Guidelines) (Tunkel et al, 2020).…”