Kids with nosebleeds

The Pediatric Insider

© 2013 Roy Benaroch, MD

Isaac asked, “What’s the best way to deal with a nosebleed? What if your child gets a lot of them?”

A single nosebleed, or even a few of them in a row, is rarely anything to worry about. Have your child sit up, maybe leaning forward a bit, and pinch the fleshy end of the nose shut. Be gentle—it doesn’t take a hard squeeze. Then resist the temptation to check too soon. Once you let go, if it’s still bleeding you have to hold it even longer the next time. So start with a 5-minute hold, and if that doesn’t work 10 minutes, and if even that doesn’t work, try 10 minutes again on your way to the ER to get the nose packed. You can also try putting some ice (or a bag of frozen peas) on the bridge of the nose to decrease blood flow.

You may have heard that people with nosebleeds ought to lie down, or lie back. That’s not a great idea. More blood will be swallowed that way, and blood in the stomach can cause vomiting.

Nosebleeds often happen in a little group, one after the other for a few days, until the clot gets strong. After one nosebleed, even a little bit of nose trauma, a rub or a blow, can lead to more bleeding for a few days.

Most nosebleeds are caused by picking (or, as we say, “digital trauma.”) So encourage Junior to keep his or her fingers out of there. Nosebleeds also happen when the lining of the nose is dry and cracked. In the winter, a humidifier or nasal saline gel can help keep the lining of the nose from drying out. Anyone with an irritated nose, say from second hand smoke or allergies, is going to rub their nose a lot, which can lead to nosebleeds, too. Oral allergy medications, like Zyrtec or Claritin, can help relieve the itchy feeling that accompanies allergies, so those might help prevent rubbing and nosebleeds, too. The prescription allergy medications that are sprayed up the nose might make nosebleeds better, but might actually make them worse by thinning the tissue inside the nose.

If nosebleeds are accompanied by signs of other bleeding, like gum bleeding or easy or unexplained bruising, your child needs to be evaluated for a bleeding disorder. Sometimes these run in families. Siblings might have easy bruising or heavy menstrual periods, or a family member might have had excessive bleeding after a tooth extraction. Any family history that suggests a bleeding disorder should be discussed with your child’s doctor.

If a bleeding disorder isn’t suspected, the next step for children with frequent nosebleeds is an evaluation by an ENT (ear, nose, and throat specialist.) Often, there’s an exposed blood vessel that can be chemically cauterized in an office procedure to prevent further re-bleeding.

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