This was a topic discussed by Dr.Abhijit Misra at Siliguri December 2024 :43rd West Bengal State Pedicon Uttorcon 2.0
children
Looking for a Pediatric Dentist?This is what you should know!
Are you looking for a Pediatric Dentist near you?Word of mouth from a patient is probably your best chance of getting a great Pediatric dentist .
Who Is A Pediatric Dentist?
A pediatric dentist specializes in the treatment of children from infancy through early adulthood and special needs patients.
After receiving their dental degree, they spend an extra 3 years in a training program specifically designed to train them on how to manage children and those with special needs.
Children are not just small adults! Their teeth, brains, physiology, and temperament are very different from adults and pediatric dentists are trained to manage all of those differences.
Why Are Baby Teeth So Important?
Primary, or โbaby,โ teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt. When do the Primary Teeth Develop & Erupt?
Primary teeth begin developing between the 6th and 8th week of fetal development. The permanent teeth have begun to form by the 20th week of fetal development. The first primary teeth to erupt are usually the lower central incisors around 6 months of age. The American Academy of Pediatric Dentistry recommends a childโs first dental visit be within 6 months of the eruption of the first tooth or by 1 year of age. All 20 baby teeth usually erupt by 3 years of age. Exact sequence of eruption varies slightly depending on the child. All 20 baby teeth will be replaced by a permanent successor.
The permanent teeth begin to erupt around 6 years of age. The first teeth to erupt are usually the 6 year molars (1st molars) and the lower central incisors. The full permanent dentition is 32 teeth, which includes the wisdom teeth (3rd molars).
How Can I Help My Child in a Dental Emergency?
Toothache:
First, rinse the mouth or affected area with warm salt water. If the face is swollen place a cold compress on the area and call your pediatric dentist immediately. Give Paracetamol or Ibuprofen for pain and see a dentist as soon as possible.
Cut or Bitten Tongue, Lip or Cheek:
Quickly apply ice to the affected area to help with swelling. Try to control bleeding by applying firm pressure to the affected area. If simple pressure does not control bleeding, it is important to see a doctor or visit the hospital emergency room.
Knocked Out Permanent Tooth:
Quickly try and find the tooth. Rinse the tooth with water and try to handle the crown, not the root, of the tooth. DO NOT clean off any tissue that may be still attached to the root. If the tooth does not appear to be fractured and the child is cooperative, try and reinsert the tooth into the socket. Have the child bite on a washcloth or gauze to hold it in place. The tooth can also be transported in โSave a Toothโ solution, childโs own saliva, or milk. Time is critical. The child must see a dentist very quickly for the most favorable outcome.
Knocked Out Baby Tooth:
This is usually not an immediate emergency and examination can be delayed until normal business hours. Usually, no treatment is necessary.
Broken, Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist as soon as possible. Early treatment can prevent infection and reduce the need for extensive dental treatment. Sometimes the fractured tooth can be reattached. If possible, save the fractured piece and bring it in to the dentist.
Chipped or Fractured Primary Tooth:
This is usually not an immediate emergency. Contact your pediatric dentist to schedule an evaluation of the affected area.
Severe Head Injury and/or Possible Broken or Fractured Jaw:
Keep the jaw stable and visit the nearest emergency room immediately.
What is Pulp Therapy / Nerve Treatment?
The pulp (nerve) is the most center part of the tooth. It contains blood vessels, nerves and reparative cells. When the cavity of a tooth is into the nerve or, sometimes even when it is close to the nerve, a โpulpotomyโ (nerve treatment) must be completed to maintain the vitality of the tooth. Sometimes, a โpulpectomyโ is performed and this is just a more extensive version of the pulpotomy. Either treatment is an effort to maintain the tooth as long as possible.
Once the affected nerve tissue is removed, an antibacterial agent is placed to prevent bacterial growth and calm the nerve tissue. The nerve treatment is followed by a permanent restoration, which is usually a stainless steel crown.
What is the Best Time for Orthodontic Treatment?
Pediatric dentists are trained to recognize possible issues with the developing dentition. Early treatment can prevent more extensive dental problems in the future. Some dental malocclusions (bad bites) can be recognized as early as 2-3 years old.
Children have 3 different phases of tooth development. The first phase is all primary (baby) teeth from 2-6 years old. During this time in a childโs life we are concerned with underdeveloped dental arches, premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated during this phase can have great results and may in some cases prevent need for future orthodontic treatment.
The second phase is called โmixed dentitionโ and this happens from around 6-12 years of age. This phase has both permanent and primary teeth and begins when the 6 year molars and lower central incisors begin to erupt. Treatment concerns and goals during this time of a childโs life are directed at correcting jaw relationships by redirecting growth and aligning teeth that are excessively out of place. When indicated, treatment during this phase is very successful because the hard and soft tissues are very responsive to orthodontic movement.
The last phase of a childโs dentition is when all adult teeth are present and this is when we make the final decision as to whether or not the child would benefit from orthodontic treatment.
Author :Dr.Amrita Pal
About Dr. Amrita Pal (BDS,MDS-Pediatric Dentistry)
I am a Pediatric as well as General dental surgeon by profession, previously attached to Medical College.
Also read
Does Sugar cause dental caries
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Nose bleed and Thalassemia
Nose bleeds in children are common.In nine out of ten cases its due to nose picking.It’s the rest which we need to rule out.
What you should do if your child has nose bleed?
1)Don’t panic.Seeing you panic or cry will scare your child scared and he/she will start to cry.This can cause the nose bleed to become worse.
2)Pinch the nose and ask child to breathe gently through the mouth.Child should be bending forward over a wash basin ,or you can hold a vessel in front of his mouth .
3)Talk to the child gently and calm him down.
4)You can then hold a cold damp cloth over the nose bridge.This helps control bleeding too.Pinching the nose helps stop bleeding within 5 to 10 minutes.
When should you worry and visit your nearest emergency?
1)If the bleeding happens for longer than 10 minutes.
2)Happens frequently and takes a long time to stop .
3)Bleeding also from other places ,like from gums,while peeing etc.
4)Baby is very pale and blood tests show hemoglobin to be low .
5)Even minor cut injury ,takes a long time to stop.
6)There is history of swelling of knee and other parts of body with discolouration even with minor trauma.
7)When bleeding causes baby to become lethargic.
8)There’s family history of similar bleeding.
9) There’s family history of consanguinous marriage.
10.Preconceptional testing not done for Thalassemia.
11.Family history of Thalassemia trait in one parent and other not tested.
What tests will your doctor suggest?
If its the first episode and bleeding stopped quickly few tests may be suggested depending on history and clinical examination
But if the doctor has grounds for clinical suspicion ,a thorough checkup may be needed.Nasal bleeding can sometimes be a danger sign of bleeding problems like, Thalessemia,Haemophilia and Leaukemia and other bleeding disorders.
A complete blood work up like:
- Haemoglobin
- Complete blood counts
- Platelet levels
- Prothrombin time
- APTT(Activated partial thromboplastin time)
- Liver function test
- Peripheral blood smear
- Haemoglobin electrophoresis to rule out Thalessemia
Radiology can be suggested keeping in mind history and clinical features. CTPNS (Computed tomography Paranasal sinus) helps rule out nasal masses.
If nose bleeding is due to trauma, it will stop with the first steps explained.After that nose drops ,oral antibiotics and topical antibiotic creams will be prescribed.One of the commonest preventable cause of nose bleeding in children is Thalessemia.
This prevention happens through blood tests done before marriage or atleast before planning to have a baby(preconception test).
Even now with massive awareness around this disease,there is multiple examples of Thalassemia baby ,especially in Eastern part of India
Data
Every year 10,000 to 15000 babies are born with Beta Thalassemia major in India.
India
1.5% of Global population are Beta Thalassemia carriers.60,000 new symptomatic patients every year make this a cause for concern.
Thalassemia Screening is crucial
High prevalence of Thalassemia in the Indian subcontinent.Carrier state high and often goes undiagnosed because it’s remains asymptomatic except for anemia .
Awareness about pre-marital counseling and tests – for all couples should be mandatory to avoid unfortunate problems.
For arranged marriages its highly adviced to avoid marriage between two individuals with Thalassemia trait.High risk of Thalassemia Major babies in couples with carrier state in both parents.
Nose bleeds in kids :3 Things you must know
Management of Pediatric epistaxis:Scientific Paper
Juvenile Nasopharyngeal Angiofibroma
Previously published on mycity4kids
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Thalassemia Screening :Why You Need to Know About this!
High prevalence of Thalassemia in the Indian subcontinent makesย 8th May Thalassemia day specially important. Thalassemia is a major public health concern in India.
Eastern India shows a high incidence as also Sindhis..Carrier state high and often goes undiagnosed because it’s remains asymptomatic except for anemia .
Awareness about pre-marital counseling and tests – for all couples should be mandatory to avoid unfortunate problems.High risk of Thalassemia Major babies in couples with carrier state in both parents.
India has the largest number of children with Thalassemia major in the world โ about 1 to 1.5 lakhs and almost 42 million carriers of ร (beta) thalassemia trait. About 10,000 -15,000 babies with thalassemia major are born every year.
India accounts for 25% of global,people living with Beta Thalassemia census.
Since there’s a high prevalence of hemoglobinopathies in the eastern part of India, routine premarital screening and genetic counseling is a must.
There’s is upto 19% of Beta thalassemia trait in the Indian population.The Prevalence ranges between 5%to 17% in certain populations.But usually between 3 to 5%
What can be done?
Premarital and pre-natal screening must be made mandatory .
Genetic Counseling
Make testing incentivized.
Screen and educate relatives of all known patients wuth Beta thalassemia and carriers .This will help reach those at risk quickly .
Mandatory screening of all kids at birth.
Affordable tests .
Conclusion:
Transfusion still remain the major modality of treatment. This together with the poor quality of life in the patient and family due to frequent,recurrent transfusions make this a particularly serious problem.
Reference:
https://pubmed.ncbi.nlm.nih.gov/37947120/
https://www.pib.gov.in/PressReleseDetailm.aspx?PRID=1841433
https://journals.innovareacademics.in/index.php/ajpcr/article/download/47258/28122
https://journals.lww.com/jfmpc/fulltext/2024/13040/quality_of_life_and_thalassemia_in_india__a.7.aspx
Jawahirani A, Mamtani M, Das K, Rughwani V, Kulkarni H. Prevalence of ?-thalassaemia in subcastes of Indian Sindhis: Results from a two-phase survey. Public Health 2007;121:193โ8
https://www.researchgate.net/publication/375549144_Current_Status_of_b-Thalassemic_Burden_in_India
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Autism Care and Screentime #WorldAutismDay
Screentime is an addiction.Lets accept that. On World Autism Day I will share my experience at the Sishumangal Child Development Centre and Research Institute Raigunj where they had an interesting panel discussion on the screen usage it’s effect on kids and what is a safe zone.
Autism spectral disorder represents a range of neurodevelopmental condition presenting with challenges in social skills language delays and presents in various degrees of severity.A genetic component is there, but environment has a role to play to especially those on the borderline of the spectrum .Early childhood parental interaction ,avoiding screentime ,and early diagnosis of speech or language delay will go a long way in fighting the battle.
Most research is from TV watching data.
Research for tablets, smartphones is still limited.Based on survey results:
Over 40% of children regularly watched TV, DVDs, videos by 3 months.
By 24 months, this rose to 90%.
Children 0-24 months watch approximately 2 hours of TV/day in the US.
In 2017, the Hospital for Sick Children in Toronto presented research regarding the relationship between screen time and language development .
Around 900-1,000 children, ages 6-24 months folowed between 2011-2015.By their 18-month check-ups, 20 percent of the children had daily average handheld device use of 28 minutes, according to their parents.
Used the ITC- Infant Toddler Checklist.
RESULT: Infants with more handheld screen time have an increased risk of an expressive speech delay.Every 30-minute increase in handheld screen time was linked to a 49% increased risk of โexpressive speech delayโ (i.e. score below the 10th percentile in the symbolic, social or the total score of the ITC).
Guidelines for Screentime by AAP
- Birth-18 months = no screen time; facetiming
- 18-24 months = high-quality programming- CO-VIEW
- Blueโs Clues, Sesame Street, Barney
- 2-5 years = 1 hour daily of high-quality programming- CO-VIEW
- 6+ = make sure it isnโt replacing sleep, physical activity, etc.
- Be consistent with how long kids can watch media
- Designate media-free times: dinner, driving, one hour before bed
- Watch WITH your children: โmindful useโ
American Academy of Pediatrics, 2016
Screen exposure increases the sensori overload that can cause even more difficulty I communication in kids who haven’t yet developed speech.
Speech and language development delay occurs if children exposed to screen less than 18 months of age.
Data shows that :
Less than 3 months screen exposure 40%
By 2years 90%
By 10 years personal phone!
There’s a problem right there.
Happinetz or similar device is a good solution right,out of the gate for young kids developing screen addiction.Remember the tantrums now are better than what happens later.
But in this scenario I will tell you a problem we adults are facing too.In this rapidly changing world of bricks and cements we are stick indoors with no physical activity.The smart phone is a whole world right from your palm and when you take out that phone to scroll and refresh instagram/Facebook/X for random number of times we are not walking the talk.I am guilty of that too.But I am also a digital creator for health and educational content.The solution lies in choosing where and how to spend our time .It’s not going to be easy .But nobody said it would be !
Sishumangal Child Development Centre and Research Institute is doing their best to spread awareness and help the kids and parents requiring special help,training and support .
Know about managing Internet Access for kids
This is part of Blogchatter A2Z challenge C post and the Ultimate Blog Challenge .
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Management of Paediatric epistaxis in different age group in a tertiary care centre
This article was written and published back in 2016 when I was working as a teacher at Malda Medical College. Sharing it on the Blog for the first time,
TITLE PAGE: Management of Paediatric epistaxis in different age groups in a tertiary care centre
Type of Article: Research Article
Abhijit Misra1*, Amrita Basu2, Prabir Kr Mandal2, Nepal Ch Mahapatra1
1Department of Paediatric Medicine, Malda Medical College, West Bengal, India 2Department of Otorhinolaryngology, Malda Medical College, West Bengal, India
ABSTRACT
Background: Epistaxis is a common otorhinological emergency seen in children. Aetiology and treatment differ in different age groups.
Methods: A retrospective study was conducted in a tertiary care hospital and data of pediatric patients (under 18 years) admitted with Epistaxis were divided into three different age groups Gr A (2 years to <5 years), Gr B( 5 to < 12 years) and Gr C (12 years to 18 years) and analyzed.
Results: Out of 216 total patients males outnumbered females in all age groups. Trauma including nose picking was the most common cause in all three age groups (54%, 45.4%, and 31% respectively). 2nd most common cause noted was Blood dyscrasia in Gr A (17.5%), idiopathic in Gr B (23.8%), and Gr C (22.5%). Tumours accounted for 11.3% of patients in Gr C. Observation alone (i.e. nasal mucosal hydration, use of topical decongestants, topical antibiotics) were the main intervention needed (70% in Gr A, 50% in Gr B, and 28% in Gr C). Nasal packing and other methods were needed mainly in the older age Groups. 61% of traumatic patients managed with observation alone whereas 55.8% of inflammatory group and 66.7% of blood dyscrasia group needed nasal packing for control of Epistaxis.
Conclusions: Trauma including nose picking is the most common cause of pediatric epistaxis among all age groups and usually managed well with observation alone. Nasal packing and other invasive treatment modalities are mostly needed in older age groups of pediatric patients and those with non-traumatic causes of epistaxis.
INTRODUCTION
Epistaxis is a common problem in paediatric population. Most are spontaneous, anterior and self-limiting. Gently pressing the nasal ala for 5โ10 min is usually all that is required. Up to 60% of children will have had at least one nosebleed by age ten. Commonly occur between the ages of 3 and 8 years, the incidence declines in adulthood. However 50% of all adults presenting with epistaxis had epistaxis during childhood.1 Children younger than 2 years rarely present with Epistaxis.2 Epistaxis also occurs more frequently in dry environments such as in the desert or in the winter in the cooler climates, where, the lack of humidity dries the mucosa of the anterior nasal septum. Most often, these nosebleeds tend to be minor and are relatively easily managed with pressure or stop spontaneously.3 Nonetheless; epistaxis may herald a developing neoplasm, particularly if bleeding is predominantly unilateral and is associated with a history of nasal obstruction. The etiological profile of epistaxis has been reported to vary with age and anatomical location .The treatment of epistaxis also requires a systematic and methodical approach, and options vary according to the cause, location, and severity of the haemorrhage.4-9 Very few data are available regarding aetiology and treatment protocols in different paediatric age group. We here, report our experience in a tertiary care hospital about the aetiology, management aspects of this issue. The results of this study will help in planning of preventive strategies and establishment of management protocols.
METHODS
This was a retrospective observational study conducted in a tertiary care hospital in eastern India. Data of paediatric patients (children under 18 years of age) admitted with Epistaxis were collected from hospital records from January 2013 to January 2016. Patient particulars, demographic profile, eiology identified, investigations and treatment needed during hospital stay noted. Children were divided into three different age group Gr A 2years to <5 years, Gr B % to < 12 years and Gr C 12 years to 18 years. Data were then tabulated and analysed.
RESULTS
Total 216 paediatric patients of less than 18 years were admitted during the study period. Males outnumbered females in all the three age groups. Demographic data of the patients were detailed in Table 1. Family history of Epistaxis was present in 14% of Gr A patients compared to 5.7 % in Gr B and 5.6% in Gr C. History of consanguinity noted in 15.8% of Gr A compared to 6.8% in Gr B and 9.8% in Gr C patients.
Most common cause of Epistaxis identified was trauma including nose picking in all the three age groups (54%, 45.4%, and 31% respectively in Gr A, B and C). 2nd most common cause noted was Blood dyscrasia( including leukemia,haemophilia,thrombocytopenia, thalassemia) in Gr A (17.5%), whereas idiopathic was 2nd most common cause in Gr B (23.8%) and Gr C (22.5%). Tumours including Angiofibroma, polyp accounted for 11.3% of patients in Gr C and nil in other age groups. Inflammatory causes like rhinitis, sinusitis, adenoiditis, allergy and 5 cases of foreign body accounted for rest the cases. (Table 2)
Different treatment modalities needed summarised in Table 3. Observation alone (i.e. nasal mucosal hydration, use of topical decongestants, topical antibiotics and removal of foreign body in selected cases) were the main intervention needed in 48% of overall patients(70% in Gr A, 50% in Gr B and 28% in Gr C). Nasal packing and other methods were needed mainly in the older age Group of patients (Gr B and C). Table 4 summarised the different successful treatment modalities needed for different age group of patients.
61% of traumatic patients managed with observation alone whereas 55.8% of inflammatory group and 66.7% of blood dyscrasia group needed nasal packing for control of Epistaxis. (Table5)
Table 6 enlists the average hospital stay needed for different treatment modalities. Observation and electro cauterisation patients needed least no of hospital stay.Those needing surgery or multiple modalities of treatment for control of Epistaxis .needed maximum number of hospital stay..
DISCUSSION
Epistaxis is a common condition in children. Thirty percent of children under 5โ
years of age, 56% of those aged 6โ10โ
years, and 64% of those aged 11โ15โ
years, have had a least one episode of epistaxis.10 Males are more commonly affected than females in our study which correlates with other similar studies.11-13In our study family history of Epistaxis was present in 7.9% of total paediatric cases as compared to 10% in a study by Barkowitz,11 26% by Damrose12 and up to 46% by Davies K.1Children in the age group of 2-5 had the highest incidence of positive family history and also the history of consanguinity. This is further supported by the fact that this group had higher incidence of blood dyscrasia, as aetiology of epistaxis.
A committed search for the bleeder as well as a deliberate effort to find the cause of epistaxis is necessary, because too many cases of epistaxis are grouped as idiopathic or primary.14 Most common cause of paediatric epistaxis identified was trauma including nose picking in all the three age groups in our study which is similar to finding in other studies.1,3 Younger patients and those with a previous history of emergency department attendance are more likely to have a bleeding diathesis.15,16 In our study 2nd most common cause noted was Blood dyscrasia in less than 5 year age group patients whereas idiopathic was 2nd most common cause in older children(Gr B and C). Unilateral nosebleeds in association with facial swelling, pain or nasal obstruction are concerning features suggestive of more unusual causes such as tumours. In adolescent males, juvenile nasopharyngeal angiofibroma, a rare highly vascular benign tumour which is locally aggressive, may present with symptoms of painless nasal obstruction with severe epistaxis. 17 Tumours including Angiofibroma accounted for 11.3% of patients in Gr C but nil in other age groups in our study.
Frequency distribution for causes of epistaxis looks unique in children as compared with adults. Therefore, identification of the cause is important, as it strongly reflects the management plan.16 Observation with nasal mucosal hydration, topical antibiotic ointments and nasal decongestants were the main intervention needed in 48% of all patients (70% in Gr A, 50% in Gr B and 28% in Gr C). Nasal packing and other methods were needed mainly in the older age Group of patients (Gr B and C). These findings are similar to the results of the studies by Davies K1 and J F Damrose12.Topical antiseptic cream does appear to assist in reducing the frequency of nosebleeds in clinical practice, and a randomised control trial of 103 children demonstrated that 4โ
weeks treatment with 0.5% neomycin + 0.1% chlorhexidine cream (Naseptin) is effective (relative risk reduction 47%, absolute risk reduction 26%, number needed to treat 3.8), 18although not statistically significant, according to recent a Cochrane review.
In present study 61% of traumatic patients managed with observation alone whereas 55.8% of inflammatory group and 66.7% of blood dyscrasia group needed nasal packing for control of Epistaxis. In children with epistaxis secondary to underlying haematological coagulopathies, the primary focus is on correcting underlying clotting problems where possible, and/or the use of topical haemostatic agents.19 Patients with nasal mass lesion or with adenoid hyperplasia were managed with surgical removal of the lesion.
Observation and electro cauterisation patients needed least no of hospital stay. Those needing surgery or multiple modalities of treatment for control of Epistaxis, needed maximum number of hospital stay. These observations are in concordance with the literature.3
CONCLUSIONS: Trauma including nose picking is the most common cause of paediatric epistaxis among all age groups and usually managed well with observation alone(i.e. nasal mucosal hydration, use of topical decongestants, topical antibiotics). Nasal packing and other invasive treatment modalities are mostly needed in older age group of paediatric patients and those with non-traumatic causes of epistaxis. Blood dyscrasia is an important cause especially in younger age group and those with recurrent bleeds and needs packing other than transfusion of the deficient product. Tumours should be suspected in adolescent age group with unilateral nasal obstruction and need surgical treatment.8
ACKNOWLEDGEMENTS
Authors are thankful to all the faculty members of the department of Pediatric medicine and Otorhinolaryngology for their cooperation in collecting and analysing the data.
DECLARATIONS
Funding: none
Conflict of interest: none declared
Ethical approval: not needed
REFERENCES
- Davies K, Batra K, Mehanna R, Keogh I. Pediatric epistaxis: epidemiology, management & impact on quality of life. Int J Pediatr Otorhinolaryngol. 2014 Aug;78(8):1294-7.
- N. McIntosh, J.Y. Mok, A. Margerison. Epidemiology of oronasal haemorrhage in the first 2 years of life: implications for child protection. Pediatrics 120 (2007); 1074โ1078.
- Anish K Gupta, Sandip Jain, Devinder Pal Singh, Ashwani Jindal, Kuldeep Singh. Epistaxis: Management Protocol As Per Etiology. Clinical Rhinology: An International Journal September-December 2009;2(3):43-46.
- Ciaran SH, Owain H. Update on management of epistaxis. The West London Medical Journal 2009; 1:33-41.
- Walker TWM, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004. Clin Otolaryngol. 2007; 32:361-5.
- Pope LER, Hobbs CGL. Epistaxis: an update on current management. Postgrad Med J.2005; 81:309-314.
- Nash CM, Field SMB. Epidemiology of Epistaxis in a Canadian Emergency Department. Israeli Journal of Emergency Medicine 2008; 8:24-28.
- Pallin DJ, Chng Y, McKay MP, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of epistaxis in US emergency departments, 1992 to 2001.Ann Emerg Med. 2005; 46:77-81.
- Bernius M, Perlin D. Pediatric ear, nose, and throat emergencies. Pediatr Clin North Am. 2006; 53:195.
- Petruson B. Epistaxis in childhood. Rhinology 1979; 17:83โ90.
- N.J. Brown, R.G. Barkowitz. Epistaxis in healthy children requiring hospital admission. Int. J. Pediatr. Otolaryngol. 68 (2004); 1181โ1184.
- J.F. Damrose, J. Maddalazzo. Pediatric epistaxis. Laryngoscope 116 (2006); 387โ393.
- S. Loughran, E. Spinou, W.A. Clement, R. Cathcart, H. Kubba, N.K. Geddes. A prospective, single blind, randomized controlled trial of petroleum jelly/ vaseline for recurrent pediatric epistaxis. Clin. Otolaryngol. 29 (2004); 266โ269.
- Watkinson JC. Epistaxis In: Scott-Brownโs Otorhinolaryngology 6th ed. Vol. 4, Oxford Boston: Butterworth-Heinemann; 1997: 4/18/ 1-17.
- Elden L,Reinders M, Witmer C. Predictors of bleeding disorders in children with epistaxis: Value of preoperative tests and clinical screening. Int J Pediatr Otorhinolaryngol. 2012;76:767โ71.
- Magy S. Abdel Wahab, Hesham Fathy, Rania Ismaila, Nancy Mahmoud. Recurrent epistaxis in children: When should we suspect coagulopathy? The Egyptian Journal of Otolaryngology 2014; 30:106โ111.
- Siddiq S, Grainger J.Fifteen-minute consultation: investigation and management of childhood epistaxis. Arch Dis Child Educ Pract Ed. 2015 Feb;100(1):2-5. doi: 10.1136/archdischild-2013-304931. Epub 2014 Jul 17.
- Kubba H,MacAandie C, Botma M, et al. A prospective single-blind randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood. Clin Otolaryngol2001;26:465โ8.
- Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev 2012;(9):CD004461.
Healthwealthbridgeย Disclaimer health information provided on this blog is for general awareness and doesnโt in any way replace a doctorโs professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet.
Previously published in International Journal of Contemporary Pediatrics in 2016 Management of pediatric epistaxis in different age group in a tertiary care centre .
