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Am Fam Physician. 2014;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.

What are the effects of treatments for recurrent idiopathic epistaxis in children?
Likely to be beneficialAntiseptic cream (containing chlorhexidine hydrochloride plus neomycin sulfate)
Unknown effectivenessPetroleum jelly
Silver nitrate cautery


Recurrent idiopathic epistaxis is recurrent, self-limited nasal bleeding for which no specific cause is identified. There is no consensus on the frequency or severity of recurrences. This review includes evidence for children one to 16 years of age with recurrent idiopathic epistaxis. Epistaxis caused by other specific local factors (e.g., tumors) or systemic factors (e.g., clotting disorders) is not considered here.

Incidence and Prevalence

A cross-sectional study of 1,218 children (11 to 14 years of age) found that 9% had frequent episodes of epistaxis. It is likely that only the most severe episodes are considered for treatment.

Etiology/Risk Factors

In children, most epistaxis occurs from the anterior part of the septum in the region of the Little area (Kiesselbach plexus). Initiating factors include local inflammation, mucosal drying, and local trauma (including from nose picking).


Recurrent epistaxis is less common in persons older than 14 years, and many children grow out of this problem.

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