Nosebleeds: A quick guide to prevention and treatment in children

The Pediatric Insider

© 2017 Roy Benaroch, MD

Frequent commenter wzrd wrote in, “Perhaps in the future, a timely article on epistaxis, specifically seasonal/winter related? I used to have the worst nosebleeds in the winter as a child, literally filling bath towels with blood. I’m sure that you’d have excellent insight into the worthiness of cautery in severe cases.”

Wzrd here is asking about epistaxis, usually called a “nosebleed” by most people. I have no idea why doctors need a separate word for everything. Hey! Were you curious about where that word, epistaxis, comes from? “Epi” shows up in a lot of medical words, like epidermis or epiglottis – it means “upon.” The “staxis” means to “to let fall in drops,” sharing the same root as “stalactite”. Which doesn’t necessarily mean nosebleeds are like stalactites hanging off your face. Isn’t language fun?

Winter nosebleeds are often caused by dry, hot air pouring out of the furnace. That dry air sucks the moisture out of the lining of the nose. Little cracks form, which are itchy and irritated. Junior rubs or picks his itchy nose, and nosebleeds start. Once a nosebleed begins, it will clot off—omnes sanguinem clausuris—but the clot is never as strong as the intact blood vessel. So children typically get a few nosebleeds in a row, over a few days, as they continue to rub their itchy dry nose.

Parents need to make sure there isn’t some other kind of issue going on. If a child has nosebleeds accompanied by other bleeding—like bleeding under the skin, or gum bleeding—or if there’s a strong family history of excessive bleeding, then a blood workup for a bleeding disorder is needed. Most of the time, though, nosebleeds are just nosebleeds.

Nosebleeds, as wzrd said, can sometimes bleed a lot, even soaking sheets or towels. (More medical lingo fun: in doctor-talk, we call that “bleeding like stink.” I don’t know the Latin roots of that phrase.) To treat a nosebleed, 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 should hold it even longer the next time. 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.

To prevent nosebleeds, keep the air as humid as possible. A vaporizer or humidifier can help, especially one that really pours out the mist. A good humidifier will use at least a gallon of water to humidify a child’s bedroom every night. Many nosebleeds are also caused by picking (or, as we say in Latin, “digital trauma.”) You may want to encourage Junior to keep his or her fingers out of there.

You can also moisturize your child’s nose by having him snort some saline nasal gel. Dab a blob of this gel—it has the consistency of toothpaste—on a fingertip, and have your child snort it up into his nose at bedtime. They also make swabs of saline gel, but the swabs themselves are stiff and can irritate the lining of the nose if used too aggressively.

If nosebleeds are frequent or problematic, and these simple steps haven’t helped, the next step would be to visit an ENT specialist (or an “otorhinolaryngologist” – you look up the Latin. What do I look like, Google?) They can peek up the nose with a little endoscope, and see if there’s an exposed blood vessel that can be chemically cauterized. The procedure is done with a little squirt of topical anesthetic, and is reasonably easy and painless to do once a child can sit still.


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5 Comments on “Nosebleeds: A quick guide to prevention and treatment in children”

  1. wzrd1 Says:

    I had my nose packed more times than I can count. I also had chemical cautery, which is initially painless, but after, can make the worst sinus headache you’ve ever experienced seem like a comparison between a firecracker and dynamite.
    Cautery seems to be of variable worth, indeed, in more severe cases, it may actually make the bleeding worse in the long term.

    Springtime allergy season and that still running heater bring their own misery.

    One mitigation can help a great deal, a humidifier. When we lived in a Philadelphia row, we had water pans on the radiators, when we moved out to the suburbs, a whole house humidifier was installed (with an interim vaporizer set up in my room).

    I’m one of the reasons that the treatment guidelines were changed from pinch the nose and tip the head back to tip the head forward. That was because the severity was such, blood literally ran down my throat.
    Today, I just kneel in front of the toilet and let it bleed out. It’ll look like a murder scene, but at least I don’t have sinuses filled with clots.


  2. Hi Dr Roy,

    What about nosebleeds caused by heat/in summer months? I’m assuming treatment to stop bleeding is the same? What is the reason as to why this happens?


  3. Dr. Roy Says:

    Nosebleeds can occur any time of year (though more common in dry months). Treatment is the same whether winter or summer.

    Liked by 1 person

  4. […] Nosebleeds (or epistaxis) can be common in the summer months and lovely hot days we have here in Oz! Check out Dr Roy’s advice on how to manage a nosebleed.… […]


  5. bruce Says:

    I have a low platelet count and had nose bleeds for 30 years. I finally got them under control.
    I use a small 15x makeup mirror and small penlight. Every morning I look in my nose for scabbing on the sides of the nostrils. If they appear, I drink 20 ounces of an electrolyte sport drink like Gatorade, or NUUN active tablets (healthier because no sugar). Wait 45 minutes and look again. Sometimes you need to do 40 ounces. Use a bit of saline spray to moisten the scabs, and sniff. The scabs break off and tissues return to pink.Its been a miracle for me and able to prevent nosebleeds for over 4 years


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