• Bleeding is often occult in children, as they swallow blood rather than spit it out. Children can also tolerate blood loss well before decompensating. The amount of blood loss is usually more than estimated.
  • Younger children may not tolerate application of pressure to the oropharynx. Sedation may be needed but would be dependent on the skillset available as sedative agents could result in haemodynamic collapse or airway compromise.
  • All patients should have a period of observation in hospital, even if the bleeding has stopped in the emergency department.
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