Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection.

Background: Epistaxis in childhood is common but unusual in the first years of life. Oronasal blood has been proposed as a marker of child abuse.

Methods: We performed a retrospective review of all hospital notes of children in the Lothian region of Scotland who were <2 years of age and in whom facial blood had been recorded over a 10-year period.

Results: There were 77,173 accident and emergency department attendances with 58,059 admissions during the 10-year study period in children <2 years of age; 16 cases of nose bleed and 3 cases of hemoptysis were recorded. All cases of hemoptysis were associated with significant bouts of coughing and respiratory infections. Epistaxis in 8 cases was associated with visible trauma and in 4 cases with thrombocytopenia (secondary to malignancy in 3). In 2 cases, an associated apparent life-threatening event was described, and in 2 cases there was a coincident upper respiratory tract infection. Review of previous and subsequent history suggested 7 cases of "accidental" injury that might have been caused by abuse. These cases are described here. All children who presented with this problem to the accident and emergency department had been admitted for observation or management.

Conclusions: Epistaxis is rare in the accident and emergency department and hospital in the first 2 years of life and is often associated with injury or serious illness. The investigation of all cases should involve a pediatrician with expertise in child protection.