Nosebleeds

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, making them fragile and easy to burst and start bleeding.

Causes

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).

Other causes of a nosebleed may include:

Overly sensitive blood vessels that burst and bleed (such as in warm, dry weather).
Infections- including the nose, throat and sinuses.
Common colds and flu.
Allergies (such as dust mite allergy or hay fever).
Knocks or bumps to the nose.
Foreign body (such as when a child has pushed something up their nose, most commonly small beads).
Excessive straining (as occurs with constipation).
Certain medications (such as anti-inflammatory medicines or nose sprays).

First Aid

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 that that they will be fine or that 'everything is ok'. 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.

Follow these instructions:

Sit your child upright in a comfortable position, slightly leaning forward.
Squeeze the lower, soft part of the nose with your fingers, a tissue or a cloth (your child can do this if they are older) for 10 minutes.
Applying an icepack or cool, wet cloth to the bridge of your child's nose may also be helpful.
Offer your child an icypole or cold drink, this will cool them down and get rid of the 'yucky' taste of blood.
Encourage your child to 'spit' out any blood that has dripped from their nose into their mouth. Swallowed blood may make your child vomit and cause bleeding to continue or worsen.

Nosebleeds - RCH-KHI

Important: DO NOT keep checking whether the bleeding has stopped by removing your fingers. The blood needs to clot and this takes time! Reading a book or watching a video 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. Your child should not run around or play rough for a couple of hours after the nosebleed stops to prevent it from bleeding again.

Treatment

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 then a doctor will have a look up your child's nose with a special light to see if they can find the bleeding blood vessel.

The doctor may then:

Apply a cream or ointment to the inside of your child's nose (it has a special medicine that slows the blood flow).
Use Cautery (a special chemical to 'freeze' or 'burn' the blood vessel, referred to as cauterization) to stop the bleeding.
Pack your child's nose with a special gauze dressing.

For severe nosebleeds, you child may need to have a blood test to check how much blood they have lost. They may also be referred to an ENT (an Ear, Nose and Throat doctor) 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.

You may also be advised to apply some petroleum based gel or ointment (such as Vaseline) to the inside of your child's nose if it is dry and cracked (generally twice a 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 4 years of age as they are unlikely to cooperate or sit still and this method may cause injury).

Care at home

Rest your child for the next 12 –24 hours (quiet activities such as drawing, reading a book or watching television are advised).
Avoid giving your child hot drinks or food or a hot bath/shower for at least 24 hours after a nosebleed.
Tell your child not pick or blow their nose for 24 hours afterwards (a week if they have had their nose cauterized).
Your child should avoid hard exercise (running/rough play), straining or lifting anything heavy for a week.
If your child is suffering from constipation, increase their fluid intake (such as water or prune juice) and fibre in their diet (such as fresh or stewed fruit and wholemeal breads/cereals) or ask your doctor or pharmacist for a stool softener to prevent them from straining.
Sometimes a lubricating ointment or nasal spray may help. Ask your doctor or pharmacist for advice.

What to expect

Most nosebleeds cause only minor discomfort to your child.

Please note that your child may:

Be scared or distressed with a nosebleed.
Vomit after a nosebleed if they have swallowed blood. Encourage your child to spit the blood out.
Have several nosebleeds over a period of a few weeks.
Be bleeding due to an underlying medical problem, this is uncommon.

Rarely do children lose so much blood that it causes anaemia - low haemoglobin in red blood cells. This is only likely with frequent, heavy nosebleeds over several weeks or months.

Prevention

Here are some ways to prevent nosebleeds in some children, use:

A humidifier in dry, warm climates.
A lubricating ointment (such as Vaseline) inside the nostrils.
A saline nasal spray.
Headgear when playing sports.

Key points to remember

Nosebleeds are very common in children and often result from harmless activities .
Most nosebleeds cause only minor discomfort to your child. Rarely do children lose so much blood that it causes anaemia.
All emergency treatment is initially based on the First Aid principles.

For more information

See you local doctor.

Individual information

Developed by RCH Emergency Department. Last updated, March 2007.