Posted tagged ‘epistaxis’

Nosebleeds: A quick guide to prevention and treatment in children

January 9, 2017

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.

Drowsee

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Kids with nosebleeds

October 3, 2013

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.

Winter nosebleeds

December 25, 2008

Allison asked, “One of my children is constantly getting nosebleeds during the winter. We generally try to run a vaporizer in his room at night to help, but are there any other options? A friend told me about borafax — any thoughts about that as an option?”

Winter nosebleeds are caused by dry, hot air pouring out of your furnace. It dries out the lining of his nose. Little cracks form, which are itchy and irritated. Junior rubs or picks his itchy nose, and nosebleeds start. Once a nosebleed starts, it will clot off—but the clot is never as strong as the intact blood vessel. So you’ll get a few nosebleeds in a row as he continues to rub his nose and knock the clot off.

You do 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 bleeding problems, then a blood workup for a bleeding disorder is needed. Most of the time, though, nosebleeds are just nosebleeds.

To prevent nosebleeds, keep the air as humid as possible. A vaporizer or humidfier can help, especially one that really pours out the mist. If you can’t see much mist coming out, it’s not humidifying very well. A good humidifier will use at least a gallon of water to humidify a child’s bedroom every night.

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, have have him snort it up into his nose at bedtime. If he’ll do it, it works. They also make swabs of saline gel, but the swabs themselves tend to be too stiff and might damage the lining of the nose, leading to more nosebleeds.

I’m not familiar with Borafax (sometimes spelled Borofax), but with the help of Dr. Google I found that it’s a first aid cream that appears to have been taken off the market. It’s made with boric acid, a weak anti-fungal/anti-biotic, and had been touted for diaper rash and other mild skin irritations. There are some compounding pharmacies that seem to make this, or something very similar to it. I’m not sure how or why it would help with nosebleeds.