Epistaxis (recurrent) – Paediatric

This RAC is applicable to referrals for patients aged <16 years only. Please refer to the Adult ENT RAC for referrals for patients aged 16 years or more.

Emergency and immediate referrals

Referral to Emergency Department

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergency medical advice if in a remote region:

  • Foreign body (button batteries – inhaled or ingested) if suspicion of button battery immediate emergency review
  • Periorbital cellulitis with or without swelling with or without sinusitis
  • Septal haematoma
  • Severe or persistent epistaxis
  • Trauma with other associated injuries i.e. other facial fractures e.g. orbit

Immediately contact on-call registrar or service to arrange an immediate ENT assessment (seen within 7 days) for:

  • Nil

To contact the relevant service, see HealthPathways: Acute Paediatric ENT Assessment

Presenting issues
  • Epistaxis (blood nose) recurrent
Mandatory referral information (referral will be returned if this information is not included)


  • Relevant history of symptoms including frequency of episodes and approximate volume
  • Details of previous treatment and outcome

If unable to attach reports, please include relevant information/findings in the body of the referral

Referrer to state reason if not able to include mandatory information in referral (e.g. patient unable to access test due to geographical location or financial cost)

Highly desirable referral information
  • FBC
  • Coags result including Von Willebrand screening if suspected blood dyscrasia
Indicative triage category
Indicative triage category
Category 1
Appointment within 30 days
  • Epistaxis with suspicion of a tumour
  • Unilateral epistaxis in adolescent male/suspicion of juvenile nasopharyngeal angiofibroma (JNA)
Category 2
Appointment within 90 days
  • Severe recurrent epistaxis resulting in anaemia
Category 3
Appointment within 365 days
  • Epistaxis not responding to maximal medical management for > 6 to 8 weeks e.g. topical creams, no nose picking, manage allergic rhinitis
Last reviewed: 25-05-2023

More information

Email: DOHSpecialistRAC@health.wa.gov.au