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A nosebleed (also called epistaxis) occurs when a small blood vessel in the lining of the nose bursts. The inside of the nose is delicate and the blood vessels are close to the surface. This makes them fragile and easy to burst and start bleeding.
Nosebleeds are very common in children and often result from harmless activities such as your child picking their nose, blowing it too hard or too often or from getting knocked on the nose during play. The bleeding is usually minimal (even though it may look like a lot of blood when soaked in a tissue or on clothing) and brief (less than ten minutes duration).
Your child may be very distressed and upset by the sight and taste of blood during a nosebleed. Try to reassure your child and tell them that that they will be fine or that 'everything is okay'. They may be frightened that there is something seriously wrong.
Crying will make the bleeding worse, so firstly it is important for you to calm and soothe your child.
Important: DO NOT keep removing your fingers to check to see if the bleeding has stopped. The blood needs to clot and this takes time. Reading a book or watching a DVD is a good distraction for your child.
Have a clock handy so you can be sure 10 minutes has gone by. Release the nose and check if the bleeding has stopped (if the nosebleed continues then repeat the above process for another 10 minutes).
Once the bleeding has stopped, ensure your child doesn't pick or blow their nose for 24 hours. To prevent the nosebleed starting again, your child should not run around or play roughly for a couple of hours.
All emergency treatment is initially based on the first aid principles above. A nurse or doctor will show you how to hold your child's nose to stop the bleeding.
If first aid fails and the bleeding continues, a doctor will look up into your child's nose with a special light to see if they can find the bleeding blood vessel.
The doctor may then:
For severe nosebleeds, your child may need to have a blood test to check how much blood they have lost. They may also be referred to an ENT (Ear, Nose and Throat) specialist.
If your child's nose has been packed, the gauze will need to remain in place for 24-48 hours. You will need to bring your child back to the emergency department for a check up and to have the gauze removed. The doctor may have prescribed antibiotics for your child to prevent a bacterial infection while the packing is in the nose.
Do not try to remove the packing yourself. If it falls out on its own and the bleeding doesn't return there is no need to bring your child back to the emergency department.
If nasal packing is not needed then your doctor may advise you to apply an antibiotic ointment to the inside of your child's nose up to four times a day for a week or so to clear any mild infection that may be present.
If your child's nose is dry and cracked, you may be advised to apply some petroleum based gel or ointment (such as Vaseline) to the nostrils, generally twice each day for a week. This can be done by using a cotton tip and gently rubbing it on the inside of the nose (do not use this method in children under four years of age as they are unlikely to cooperate or sit still and this method may cause injury).
Most nosebleeds cause only minor discomfort to your child.
Please note that your child may:
Rarely do children lose so much blood that it causes anaemia (low haemoglobin in red blood cells). This is only to be likely with frequent, heavy nosebleeds over several weeks or months.
Some simple ways to help prevent nosebleeds in children include:
Developed by RCH Emergency Department. Last updated August 2013.