Pediatric Nosebleeds

A nosebleed is bleeding from tissues inside the nose (nasal mucus membranes) caused by a broken blood vessel. The medical word for nosebleed is epistaxis. Most nosebleeds in children occur in the front part of the nose close to the nostrils. This part of the nose has many tiny blood vessels. These can be damaged easily.

A nosebleed can look scary, but is usually not a serious problem. Nosebleeds are common in children. They happen more often in dry climates. They also happen more frequently during the winter. That’s when dry heat in homes and buildings can cause drying, cracking and crusting inside the nose. Many children outgrow nosebleeds during their teen years.

Nosebleeds can be caused by many things. Some common causes include:

• Dry air
• Picking the nose
• Blowing the nose too hard
• Injury to the nose
• Colds and allergies
• Object in the nose

In many cases, no specific cause for a nosebleed is found.

A child may be more at risk for nosebleed if he or she:

• Lives in a dry climate
• Picks his or her nose
• Has allergies
• Has a cold

The main symptom of a nosebleed is blood dripping or running from the nose. Bleeding from the mucus membranes in the front of the nose comes from only one nostril. Bleeding higher up in the nasal cavity may come from both nostrils. It may be painless. Or your child may have pain caused by an injury or an area of sore tissue inside the nose.

The symptoms of a nosebleed can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

In diagnosing a nosebleed, your healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about any recent accidents or injuries. He or she will give your child a physical exam.

Treating a nosebleed includes:

• Calming and comforting your child
• Have your child sit up and lean forward slightly. Don’t have your child lie down. This is to prevent him or her from swallowing blood. Swallowing blood may make your child vomit. Don’t have your child put his or her head between the knees. This can make bleeding worse.
• Tell your child to breathe out of his or her mouth. Gently pinch the nostrils closed for five to ten minutes. Don’t stop pinching to check if bleeding has stopped.
• Apply a cold compress to the bridge of the nose. Don’t put tissues or gauze in your child’s nose.
• If bleeding does not stop, repeat the above steps again.
• Once the bleeding stops, tell your child not to rub, pick or blow his or her nose for two to three days. This will let the broken blood vessel heal.

If your child’s nose doesn’t stop bleeding, take him or her to see a healthcare provider. In some cases the provider may apply heat to close a blood vessel. This is called cauterization. It is a quick procedure. Talk with your child’s healthcare provider about the risks, benefits and possible side effects of all treatments.

If your child has nosebleeds often, you can help prevent them in these ways:

• Run a cool mist humidifier in your child's room at night, if the air in your home is dry. Clean the humidifier regularly so germs and mold don’t grow in it.
• Teach your child not to pick his or her nose or blow it too hard.
• Put petroleum jelly inside your child’s nostrils several times a day. This is to help protect the mucus membranes.
• Use saltwater (saline) nose drops or spray as directed by your child's healthcare provider.
• Talk with your child's healthcare provider if your child has allergies that may lead to nosebleeds.
• Don’t smoke in the home or around your child.

Call your healthcare provider if:

• You can’t stop the nosebleed
• The nose bleeds again
• Your child has an injury to the head or face
• There is a large amount of blood
• Your child feels faint, weak, ill or has trouble breathing
• Your child has bleeding from other parts of the body, such as in the stool, urine or gums, or bruises easily
• An object is stuck in your child's nose