Nosebleeds: What to Do, When to Seek Help

Tis the season for decking the halls, baking cookies, writing wish lists…

and nosebleeds.

As the popular holiday song goes,

the weather outside is frightful, but the fire is so delightful…

and our kids get nosebleeds.

I remember one particular occasion, while staying in a hotel, my husband and I were sitting in the cramped bathroom with our son.  We were unravelling rolls (yes, rolls) of toilet paper and emptying the kleenex dispenser trying to stop a terrible nosebleed.  I was ready to throw in the towel, grab an actual towel, and take our son to the nearest urgent care when, finally, the bleeding stopped.  The aftermath looked like a crime scene, but it always does when your child’s blood is involved.  He seemed unfazed by the mess, but devastated when I wouldn’t allow him in the hotel swimming pool afterwards, lest his love of the cannonball caused his nose to bleed again.

Nosebleeds in children are rarely a medical emergency, and most can be treated easily at home.  But it’s a good idea to know the ins-and-outs of epistaxis (the medical term for nosebleeds) so we can treat the condition effectively, and also know when to seek outside help.

What exactly are nosebleeds?  The nose is highly vascular, which means it contains lots of blood vessels.  When the lining of the nose is disrupted, or broken, these small but superficial vessels can tear and bleed.  Most often the bleeding comes from the anterior portion of the nasal septum (the tissue and bone that separates the nostrils from each other); however, the bleeding can come from the posterior part, but this is rare in children.

What causes nosebleeds?  •Think Christmas.  Well, not the holiday itself, but a true winter environment…cold dry outdoor air, heated dry indoor air…can make kids (and adults) more prone to nosebleeds.  And as cold-and-flu season is upon us during the holiday season, runny noses that need wiped and blown get irritated…and nosebleeds happen.  Yes, let it snow, like the song of the same name also goes, but this is also a good signal that nosebleeds can occur more often.  •On the other hand, allergies, which we more often associate with the the warmer months, can cause nosebleeds anytime the symptoms include a runny, itchy nose.  And the catch-22 is that some allergy medications, which are intended to curb nasal drainage by drying up the nasal passages, can also make a person more prone to nosebleeds.  •Injuries can also cause nosebleeds anytime of year; it doesn’t help that the nose, um, sticks out.  It’s anatomically positioned to be a prime target for a smack with a soccer ball.

What’s the best way to stop a nosebleed?  •Have your child sit quietly (easier said than done!), and leaning slightly forward, tilt her head forward as well.  •Help her pinch her nostrils closed just below the nasal bone (septum).  Then apply gentle pressure up against the bone.  •Pinch and apply pressure for at least 5 and up to 10 minutes.  •Place a cold compress or an ice pack over the bridge of the nose, too.

What shouldn’t I do?  •Don’t have your child lay down or tip her head back (the latter is a common mistake); swallowing blood can induce coughing and a persisting nosebleed.  •Don’t try to “get rid of the clot” by having your child blow her nose (also a common mistake), even if her nose “tickles” from the bleeding.  Blowing can also cause the bleeding to continue.  •Don’t peek.  While it is tempting to check to see if the bleeding has stopped, and time drags impossibly long for kids, resist the urge.  Hold pressure for at least 5…some sources recommend 10…minutes. •This is a tough one:  for about a day, discourage physical activity that raises the heart rate as this can cause a recurrent nosebleed.  Swimming should be off-limits as well, especially if your child likes to repeatedly jump in the pool:  the intense irrigation of the nose can open up healing tissue and, yes, cause bleeding.  (I’ve made this mistake more than once.  And it can cause the lifeguard to think your child has hit her head in the pool…we’ve been there, too.)  •Have a nose-picker?  Remind your child to not put her finger in her nose.  

How can I prevent nosebleeds?  While you likely won’t prevent nosebleeds entirely, there are some simple things you can do to at least decrease their frequency.  •“Don’t pick your nose!”  should be a regular reminder to your child.  •Teach your child to blow her nose gently.  •Use a humidifier to reduce dry air in your home.  Or try having your child sit in a steamy bathroom after her shower.  •If your child has had a recent nosebleed, apply an antibiotic ointment to a cotton swab and gently swipe it inside each nostril, focusing on the nasal septum.  The ointment can help reduce inflammation and promote healing.  Saline gel or drops can help, too.  •Be sure your child has appropriate, well-fitting protective head gear for sports.

When should I be concerned about my child’s nosebleeds?  Consult a healthcare professional if:

•You have tried two times (as above) to stop the nosebleed and bleeding is still present.

•Your child has had more than 2 nosebleeds in a week’s time (sources I consulted state anywhere from 1 to 4 in a week).

•If your infant has even just one nosebleed.

•If your child has a fever, a headache, or loss-of-consciousness, or feels weak or faints.

•If your child has sustained a blow to the face and you are concerned about other facial injuries.

An important note:  do not attempt to pack your child’s nose yourself (tampons are touted as a temporary measure, but don’t be tempted…).  Seek help from a healthcare professional and if necessary, she may pack your child’s nose…possibly with a RhinoRocket.  What child would be psyched about that.  After the fact, of course…

And finally, the above info applies to adults as well.  As always, with any concerns, see your doctor, too.