Nosebleeds or epistaxis

Nosebleeds (bleeding from the nose) may often scare parents, but they are not usually dangerous. They are quite common during childhood, and tend to occur more frequently in dry climates and during the winter, when the atmosphere in the house with the dry heat provided by heating (radiators, open fire) dries the interior of the nose. Some children have a tendency for frequent nosebleeds, but this often improves, and the episodes disappear during adolescence.


How do nosebleeds occur?

The front part of the nose has very dry mucous membranes, which are covered with very small vessels that can get injured relatively easily. Most nosebleeds occur in this front part of the nose, in the nostrils.

Many factors may contribute to bleeding from the nose, such as:
• Picking the nose, a common habit in many pre-school and primary school children

• Direct injury of the nose

• Overly strong blowing of the nose, resulting in rupturing some small blood vessel

• Extremely dry air

• Viruses, colds, and runny nose

• Allergies, like allergic rhinitis

• Excessive use, either in frequency or intensity, of saline solution for the nose, or suction to remove mucus

• Prolonged use of vasopressor drops to the nose (decongestants), resulting in reactive vasodilation and hemorrhage

• Foreign object in the nose, usually in children of preschool age, who may be experimenting by putting pieces of food, a toy, or paper in their nostrils.

However, it is also common for a child’s nose to bleed without apparent causes.


How can we provide first aid to a child with a nosebleed?

• First of all, calm the child down. Tension and crying may increase bleeding. Talk to the child offering help and, if necessary, lift her up.

• Compress the nostrils one towards the other for 5 to 10 minutes without interruption to see if the bleeding stops.

• Don’t put the child to lie down, but have him sit and lean forward, so he avoids swallowing blood.

• Place ice wrapped in a towel or a cold compress to the base of the nose.

• If the hemorrhaging doesn’t stop, repeat the above steps from the beginning more vigorously. Seek medical help.

• Don’t put pads, gauzes, paper, or cotton wool in the nostrils or nose.


When should the paediatrician be notified?

It is advisable to contact your paediatrician if:

• The bleeding doesn’t stop after implementing the above measures for 5 – 10 minutes, or the nosebleed recurs soon

• The nosebleed was the result of a significant blow, and may indicate something more serious, like head trauma or nose fracture

• Hemorrhaging is profuse, and the child seems to be losing a lot of blood

• The child doesn’t seem well in general, he feels weak, sick, has difficulty breathing, or may faint

• Hemorrhaging isn’t just from the nose, but the child is hemorrhaging from another part of the body (like blood in stool, blood in urine, and blood from the gums, skin hemorrhage – bruises, petechiae-red or purple spots)

• You suspect that there is a foreign object in the child’s nose (there is a smelly secretion from one side, seropurulent – a mixture of serum and pus, green)


What tests need to be done?

Usually no further tests need to be done.

In cases of repeated or intense nosebleeds, a detailed examination by an ENT doctor with anterior and posterior rhinoscopy may be required. Sometimes the ENT doctor may need to perform cauterization of the vessel that tends to bleed frequently.

Also, in cases of intense or repeated hemorrhaging, in particular if hemorrhaging in other parts of the body co-exists, a blood check for blood coagulation will need to be done.


How can you prevent your child’s nosebleeds?

So that nosebleeds don’t reoccur, you can do the following:

• If the air is dry in your child’s room, try using a humidifier during the night. The humidifier should always be cleaned as directed and regularly, so that germs and mold don’t appear.

• Teach the child from an early age (2-3 years old) how to blow his nose, and avoid putting his finger or objects in his nose

• Avoid overuse of decongestant nose drops, saline or suction

• Putting vaseline on the nostrils can help maintain the moisture of the area
• Treat allergic rhinitis and viruses appropriately (anti-allergic medicines, saline)


Stelios Papaventsis MRCPCH DCH IBCLC 2012


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