Management of Pediatric Facial Trauma

Immediate Nasal Bleeding Management

The American Academy of Otolaryngology-Head and Neck Surgery recommends applying firm sustained compression to the nasal alae for 10-15 minutes continuously without releasing pressure to control nasal bleeding in a child with facial trauma 1
Position the child sitting upright with head tilted forward to prevent blood from draining into the oropharynx and reduce aspiration risk, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1

The American Academy of Pediatrics recommends examining the upper gum and teeth systematically to identify the specific injury pattern after controlling nasal bleeding, as management differs significantly based on injury type 2
Look for missing teeth, determine if tooth is avulsed or intruded, check for tooth mobility, assess tooth position, examine for gum bleeding, and inspect for visible tooth fractures, as recommended by the American Academy of Pediatrics 2

For luxation injuries, the American Academy of Pediatrics recommends no immediate treatment for subluxation, but observation for signs of pulpal necrosis, and referral to dentist within a few days if discoloration or parulis develops 2
For avulsion, the American Academy of Pediatrics recommends not replanting an avulsed primary tooth, as replantation risks damage to the underlying permanent tooth germ 3

The American Academy of Pediatrics recommends providing caregivers with instructions for a soft diet only, restricting pacifier or thumb sucking, maintaining good oral hygiene with gentle brushing, and no routine antibiotics needed unless specific medical condition requires coverage 4

The American Academy of Pediatrics recommends immediate dental referral for extensive gingival or facial swelling, multiple teeth moving together when palpated, tooth displacement interfering with bite/occlusion, visible pulp exposure in fractured tooth, and severe extrusion or severe intrusion 2

The American Academy of Pediatrics recommends educating caregivers to watch for signs of pulpal necrosis over subsequent weeks, including gray tooth discoloration, gingival swelling near affected tooth, parulis, and increased tooth mobility 2, 3, 4

The American Academy of Pediatrics recommends considering child abuse in any child younger than 5 years with trauma affecting lips, gingiva, tongue, or palate, especially with severe tooth injury, and documenting mechanism of injury and assessing for consistency with developmental stage and injury pattern 2, 5

The American Academy of Pediatrics recommends referral to a pediatric dental specialist for dental trauma, including tooth fracture, intrusion, and luxation, as it requires prompt evaluation and management 6
The development of tooth discoloration, such as gray discoloration, after trauma is a red flag indicating potential pulp death and necessitates referral to a pediatric dentist or general dentist with high competence in pediatric care within the next few days 6

Without dental evaluation, pulpal hemorrhage and potential necrosis can progress to periapical abscess formation 6