Clinical Evidence Handbook

A Publication of BMJ Publishing Group

Recurrent Epistaxis in Children

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Am Fam Physician. 2014 Jul 15;90(2):105.

Author disclosure: Gerald W. McGarry declares that he has no competing interests.

Up to 9% of children may have recurrent nosebleeds, usually originating from the anterior septum, but most children grow out of the problem.

  • Nosebleeds may be associated with local inflammation and trauma, including from nose picking.

  • Antiseptic cream (containing chlorhexidine hydrochloride plus neomycin sulfate) may reduce nosebleeds compared with no treatment, and may be as effective as silver nitrate cautery. Such creams may smell and taste unpleasant.

  • Silver nitrate cautery is usually painful, even if local anesthesia is used.

  • Simultaneous bilateral cautery is not recommended owing to the possible increased risk of perforation of the septum.

  • Antiseptic cream (containing chlorhexidine hydrochloride plus neomycin sulfate) plus silver nitrate cautery may be more effective at reducing the frequency and severity of nosebleeds than antiseptic cream alone.

  • We do not know whether petroleum jelly speeds up resolution of recurrent bleeding compared with no treatment.

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Clinical Question

What are the effects of treatments for recurrent idiopathic epistaxis in children?

Likely to be beneficial

Antiseptic cream (containing chlorhexidine hydrochloride plus neomycin sulfate)

Unknown effectiveness

Petroleum jelly

Silver nitrate

Search date: June 2013

Adapted with permission from McGarry GW. Recurrent epistaxis in children. Clin Evid Handbook. June 2014:123. Please visit for full text and references.

This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at (subscription required)

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