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Implications for practice

Epistaxis is a rare presentation in children aged less than 2 years, however when present it is significantly associated with asphyxiation, either intentional or unintentional


Any child less than 2 years of age presenting with epistaxis in the absence of known trauma or haematological disorders warrants a full evaluation for asphyxiation as a possible cause


Some children presenting with asphyxia may have no overt symptoms; those that were symptomatic included altered skin colour, respiratory distress, altered heart rate, and a possible history of Apparent Life Threatening Events (ALTEs)


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