ABSTRACT
The assessment of children with recurrent epistaxis should begin with a careful history and physical examination. Distortion of nasal anatomy, an intranasal mass, polyps or cervical lymphadenopathy should raise the suspicion of tumour and also prompt a screen for cranial nerve palsies. It is the group of children who are most frequently referred for assessment and treatment to an otolaryngologist along with children presenting with severe acute bleeding and those children in whom an unusual aetiology is suspected. Nasal itch and blockage along with watery rhinorrhoea and sneezing are suggestive of allergic rhinitis. One should also enquire about associated nasal and systemic symptoms and any precipitating factors including trauma. No consensus exists on the standard laboratory workup for paediatric epistaxis with clinician judgement largely guiding outpatient investigations. Examination under anaesthesia may be required if bleeding continues, or in a young child unable to tolerate chemical cautery or placement of an anterior pack under local anaesthesia.
