Recurrent epistaxis in children.

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.