child holding tissue over nose: nose bleeds in children causes prevention and treatment

When a nose bleeds, it can look like a huge amount of blood, especially when the blood runs all over your child’s clothes or seeps into a tissue. This is not only distressing for you but very scary for your child as well.

The correct medical term for a nosebleed is epistaxis. Epistaxis is very common in children between the ages of 2 and 10 years old. Most children will outgrow nose bleeds by the time they hit their teens but, until then, you may need to brush up on your first aid skills and inform the school, family or friends that your child is prone to nose bleeds and tell them how best to deal with them.

Why do nose bleeds occur?

The lining of the nose (mucus membrane) is very delicate and filled with fragile little blood vessels which are very close to the surface. Any kind of irritation can cause a vessel to burst, resulting in bleeding.

If the blood is coming out of just one side of the nose then this usually indicates that the cause is the mucus membrane in the front of the nose. If your child has blood coming from both nostrils this indicates bleeding from higher up in the nasal cavity. Very often this is due to some kind of injury to the nose or a sore inside the nose.

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What are the major causes of nosebleeds?

Children living in dry climates are more likely to suffer nose bleeds. It is also more likely to happen during winter when we put heating on in our homes. The dry heat causes the mucus in the nose to dry out and form crusts or cracking. This, in turn, may result in bleeding.

Other causes of nose bleeds include:

Picking

Your child may pick or rub his or her nose if there are uncomfortable crusts inside. This can cause trauma to the mucus membrane and results in bleeding.

Blowing too hard

This may cause a little vessel to burst.

Suctioning

Parents may make use of a suction instrument to remove thick mucus from the nose. If the suction is too strong for the little vessels, it may cause bleeding.

Sinus infection

This often causes a very snotty nose and children are more likely to blow hard or pick when this is the case.

Allergy

A child with an allergic rhinitis will have a runny nose accompanied by itching. Your child will be tempted to rub or pick when this happens and cause bleeding.

Ibuprofen, aspirin or nose sprays

It is my strong recommendation never to use aspirin in a child. Aspirin can lead to all sorts of other complications, including nose bleeds. We do use ibuprofen for very high fevers or injury. It is not common for this to cause a nosebleed but keep in mind that your child may be sensitive to this medication if it has been used for some time. Using over-the-counter nose sprays may irritate the little nasal passages and cause bleeding. Certain allergy medications can also dry the nose out too much and cause bleeding.

Constipation

When a child is constipated, he or she may strain a lot to pass a stool. This can lead to a nose bleed.

Foreign body in the nose

Children love to push things up their noses. I have had the joy of removing peanuts, beads, leaves, popcorn and the likes from children’s nostrils. All of these things can cause trauma and a nose bleed.

An abnormal structure inside the nose

Your child could have a common structural problem such as a deviated septum. This can lead to crusting and bleeding.

Growths can occur in the nose

In most cases these are benign (not cancerous) but do aggravate bleeding. These growths are known as polyps and should be treated promptly.

Underlying medical problems

Please don’t panic when you read this. Serious illnesses which cause nose bleeds are very uncommon, but they do exist. If the child’s nose bleeds for a long period of time (up to an hour), is difficult to stop or is accompanied by bleeding from the gums, then a bleeding disorder may be considered. Haemophilia or von Willebrand’s disease are two such bleeding disorders. A child suffering from Leukaemia may also present with excessive nose bleeds.

child holding tissue over nose: nose bleeds in children causes prevention and treatment

How do I treat a nosebleed at home?

As mentioned before, nosebleeds are common in children and are usually easily treated at home. Once you have attended to a bloody little nose, you will soon feel confident about managing the situation.

  • If your child is crying then try to stop the tears, as the crying will make the bleeding worse. Reassure your little one that you will make it better.
  • Sit your child on your lap, preferably facing away from you so that you can sit them upright and then tilt him or her slightly forward.
  • Press the nostrils closed with your fingers and keep your fingers there for at least 10 minutes. This is to allow time for a clot to form. If you keep removing your fingers then the clot will come away and the bleeding will take longer to stop.
  • If possible, place a cold cloth or an ice-pack, wrapped in a towel on the back of the neck or on the bridge of the nose. This helps to constrict the vessels and slows the bleeding.
  • Offering your child an ice lolly or cold drink will also help slow the bleeding and take the taste of the blood away.
  • Don’t allow your child to lie down. The blood will go down the back of the throat and most likely cause vomiting. This will further traumatize your child and certainly aggravate the bleeding. Putting the head between the knees will also worsen bleeding. Upright and leaning slightly forward is what you want.

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Is there anything I can do to prevent nose bleeds?

If one looks at the common causes for nosebleeds then there are certainly steps you can take to help prevent them.

  • For the dry air, try running a humidifier in your child’s room.
  • A little petroleum jelly in both nostrils will protect the mucus membrane and prevent cracks.
  • If your child does suffer from allergies then speak to your healthcare provider about treatment.
  • Saline drops in the nose will help keep the nose moist.
  • Deal with the constipation if this is causing straining. Often increasing the child’s water intake and adding fibre to the diet, in the form of fruit and vegetables, is all that is required.
  • Teach your child not to pick or to blow too hard.

When would it be necessary to see a doctor about nose bleeds?

There are times that I would suggest that a nose bleed requires medical attention. This would include:

  • An injury to the nose, face or head.
  • An object in the nose.
  • A nose bleed that persists for longer than 20 minutes and is difficult to stop.
  • If it happens on a regular occasion – by this I mean three or more times per week.
  • If your child is under 1 year of age.
  • If your child shows signs of anaemia like weakness, lethargy (excessive tiredness) or has difficulty with breathing.
  • If the child is bleeding from other parts of the body as well or bruises easily.
  • If you suspect that your child is suffering from allergies and this is the cause of the blood nose.
  • If you have family members with bleeding problems.
  • If you as a parent are unhappy with the situation and have questions or concerns about the nosebleeds.

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What will a doctor do to treat a child’s blood nose?

The treatment will be determined by the cause of the blood nose.

  • A bleeding vessel may need to be cauterised. This is usually done by an ENT surgeon. The doctor will use a special chemical which freezes the vessel to stop the bleeding.
  • An antibiotic cream may be prescribed for inside the nose. This will help heal the nose and prevent the child from picking.
  • The nose may require packing to stop the bleeding. Gauze is packed tightly into the nose. Your child may need to stay in hospital overnight if this is necessary.
  • Polyps in the nose may need to be removed surgically. This may also apply to a deviated septum.

box of kleenex tissues : nose bleeds in children causes prevention and treatment

Conclusion

The sight of blood, especially on your little one’s face is enough to give any parent a heart attack. It is important to remember though, that nose bleeds do not necessarily mean that there is something wrong with your child. Obviously we as parents need to use our common sense.

If your child has had a bang to the head or has put something up his or her nose, you need to respond. It is really important that you don’t stuff tissues or gauze into your child’s nose yourself but instead seek medical advice.

Other than this, sit your child upright, pinch those little nostrils closed and reach for a cold compress. In all likelihood this will be over and done with in 10 to 15 minutes. Once the bleeding has stopped encourage your child to play quietly and to avoid sniffing, picking or blowing for at least 15 minutes after the bleeding has stopped. The clots may be uncomfortable but if they are disturbed the bleeding may start all over again.

One final word of comfort, parenting is not for the faint hearted, but equipped with the right information you will be able to handle a bloody little nose.

References

https://publications.aap.org/pediatriccare/article-abstract/doi/10.1542/aap.ppcqr.396068/1502/Epistaxis?redirectedFrom=fulltext
https://www.rmj.org.pk/index.php?mno=28199
https://journals.sagepub.com/doi/full/10.1177/0194599819890327
https://www.ncbi.nlm.nih.gov/books/NBK435997/
https://my.clevelandclinic.org/health/diseases/13464-nosebleed-epistaxis
https://emedicine.medscape.com/article/863220-overview

dr-enrico-maraschin-babyyumyum-expert
Affectionately known as “Dr Rico” by his patients, Dr Maraschin is passionate about preventative medicine and building trusted relationships with parents and patients is a priority to him. Well-known among the community, he is highly regarded with providing the best care for babies, toddlers and kids. He has played a pivotal role in creating his well-deserved prestige, with a particular interest in neonatology, allergies, immunology and vaccinology. Dr Enrico F. Maraschin, MBBCh (Wits), FCPaed (SA)