Epistaxis is the medical term to define bleeding from the nostril, nasal cavity or nasopharynx. A nosebleed is a relatively common and usually self-limited occurrence in childhood. However, when profuse or recurrent, it can be worrisome to children and parents. Sometimes it can be a sign of a more serious condition. Trauma from nose picking or nose rubbing accounts for most cases in children, particularly in association with inflammation from infection or allergy.
Causes of Nosebleeds
- Allergies: It can produce swelling and irritation inside the nose and may lead to spontaneous bleeding.
- Trauma: Hitting the nose, blowing it too hard, forcing objects into the nostrils, or by picking the nose.
- Colds: Especially during colds and in the winter months when the mucous membranes become dry, cracked, and crusted. It also can be associated with allergic rhinitis.
- Low humidity or irritating fumes
- Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding.
- Abnormal growths: Any abnormal tissue growth. For example, polyps in the nose may cause bleeding. Although, most of these growths (usually polyps) are benign (not cancerous), they still should be treated promptly.
- Abnormal blood clotting: Anything that interferes with blood clotting can lead to nosebleeds. For example, blood diseases (such as hemophilia) and medications, even common ones like aspirin.
- Chronic illness: Any child with a long-term illness, or who may require extra oxygen or other medication that can dry out or affect the lining of the nose, is likely to have nosebleeds.
Babies rarely have nosebleeds, but toddlers and school-aged children often do. A tendency for nosebleeds often runs in the family. Many children have nosebleeds for no apparent reason.
Most nosebleeds stop by themselves within a few minutes and are unlikely to signal serious illness. A child with severe or recurrent bleeding or bleeding from both nostrils should be evaluated by a pediatrician.
Call Your Pediatrician Right Away If:
- Your child is pale, sweaty, or not responding to you.
- You believe your child has lost a lot of blood.
- Your child is bleeding from the mouth or vomiting blood or brown material that looks like coffee grounds.
- Your child’s nose is bleeding after a blow or injury to any part of the head.
Stopping a Nosebleed
- Stay calm. Do not panic. You’ll just scare your child.
- Keep your child sitting or standing and leaning slightly forward. Don’t let him lie down or lean back because this will allow blood to flow down his throat and might make him vomit.
- Don’t stuff tissues or another material into the nose to stop the bleeding.
- Firmly pinch the soft part of your child’s nose—using a cold compress if you have one, otherwise your fingers—and keep the pressure on for a full 10 minutes. Don’t look to see if your child’s nose is bleeding during this time; you may start the flow again.
If bleeding hasn’t stopped after 10 minutes, repeat the pressure. If bleeding persists after your second try, call your pediatrician or take your child to the nearest emergency department.
Consult your pediatrician before giving your child medicated nose drops or nasal sprays to treat problems that affect the nose and respiratory passages. Although sold over-the-counter for the relief of congestion, some medications may actually increase congestion after a few days use. This increased congestion is known as the rebound effect, and can be even more uncomfortable and difficult to treat than the original problem. For a natural nose spray, try using a saline salt water spray.
While most nosebleeds are benign and self-limited, a child with severe or recurrent bleeding or bleeding from both nostrils should be evaluated by a pediatrician. If necessary, your child will be referred to a pediatric otolaryngologist (ENT) specialist.
If your child gets a lot of nosebleeds, ask your pediatrician about using saltwater (saline) nose drops every day. Doing so may be particularly helpful if you live in a very dry climate, or when the furnace is on. In addition, a humidifier or vaporizer will help maintain your home’s humidity at a level high enough to prevent nasal drying. Also tell your child not to pick his nose.