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Quick reference medical handouts used by Pediatric offices


Nosebleeds not as bad as they seem


Nosebleeds are common in children and occur most frequently in youngsters between the ages of four and 10 years. A child’s nosebleed can be a frightening experience for parents- the youngster wakes up in the morning with a blood soaked pillow or comes running into the house with their nose dripping blood like a faucet. Anatomically, the nose is the most vascular area of the body and is packed with many tiny veins and capillaries. Since the lining over these vessels is very thin, it does not take much for bleeding to start. Fortunately, most nosebleeds stop by themselves and less than 1% require treatment by a physician.

Usually, the source of the bleeding is a group of poorly protected vessels in the front part of the nose. Because of their location, these vessels are subject to frequent injury, such as forcible blowing, foreign bodies, and external trauma. The bleeding comes out of one nostril or the other and is usually easy to stop with simple first aid treatment. Much less common is the nosebleed that originates deep in the back part of the nose and flows down the back of the throat. These usually require a physician’s care in order to stop the bleeding.

There are many causes of nosebleeds and most are not indicative of a serious medical problem. Nosebleeds are frequently seen during the course of a cold, hayfever, or sinus infection because of the inflammation, swelling, and irritation of the nasal skin that occurs during these illnesses. Bleeding from the nose is more common in the winter months when homes are dry, resulting in cracked and crusted nasal membranes. Then, simply rolling over in bed at night or a good sneeze can cause the exposed vessels to break and bleed.

Protruding as it does, the nose is an obvious target for injury. A hit in the nose during contact sports, a fall from bed, or rough-housing with a friend can easily produce a brisk bleed. A less obvious cause of nosebleeds in children is nosepicking and nasal foreign bodies. Rarely, a youngster’s nosebleed may be from difficulty with blood clotting (for example, hemophilia). In these cases, there is usually a family history of a clotting problem. In addition, the child will have many unexplained bruises on their body or experience bleeding from other sites (such as their gums). Adolescent women will occasionally have nosebleeds during menstruation and repeated nosebleeds in adolescent boys may be caused by a very unusual benign tumor known as a juvenile angiofibroma. High blood pressure rarely causes a child’s nose to bleed.

Most nosebleeds stop on their own. For an actively bleeding nose, place the child in a sitting position with their head tilted forward. Immediately apply direct pressure by pinching the soft parts of the child’s nose together while pressing firmly toward the face. Hold this position for at least 20 minutes (use a timer) without releasing the pressure to check if the bleeding has stopped. This maneuver alone will stop over 90 percent of children’s nosebleeds. The most common reason for failure is releasing the pressure too soon- just as the clot is beginning to form, it is dislodged by the bleeding vessel and the nose starts bleeding again. Since crying and sniffling can prolong the bleeding, keep the child as calm as possible. After releasing the pressure, apply ice (crushed in a plastic bag or washcloth) to the nose and cheeks for the next 10 minutes. Even sucking on an ice cube or popsicle will help constrict nasal blood vessels. After the bleeding has stopped, keep the child sitting up and encourage them not to pick or blow their nose. The crust or firm clot that forms within the nose should be left alone. Never pack the nose with anything since bleeding will usually start again when the packing is removed.

If bleeding persists or recurs, parents should contact their child’s doctor or go to the nearest emergency room. Treatment might include insertion of a special packing to stop the nosebleed or, rarely, the offending vessels may need to be cauterized. Although blood coming from the nose always looks like a lot, children rarely become anemic from nosebleeds.

The prevention of nosebleeds is probably the most important aspect of their management. Adequate humidification of the child’s home environment, especially the bedroom, can be accomplished with a cold mist humidifier. The new over-the-counter saline sprays can also be helpful. The application of lubricating cream or ointment (Vaseline) just inside the front part of the nose, especially on the middle portion (septum), helps reduce crust formation. And be sure to eliminate second hand cigarette smoke from the youngster’s environment since this poison can irritate and easily dry out a child’s nasal passages.

Almost all children experience at least one nosebleed. They look worse than they really are, and simple measures such as direct pressure will stop the majority of childhood bleeds.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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