Nosebleeds in Children

Nosebleed 315

Nosebleeds during childhood are very common and usually not serious. About 30% of children under 5 years and 56% of children 6-10 years have had at least one nosebleed. But to parents, nosebleeds are often bothersome and at times frightening events.

Why do kids get nosebleeds?
About 90% of nosebleeds originate from the blood vessels in the front part of the nasal septum (the wall separating right and left nostrils) and almost always stop on their own. These blood vessels are most often damaged by:

• Nose picking
• Irritation, rubbing and vigorous nose blowing, especially with nasal allergies and during colds.
• Dryness of the nasal lining, particularly during periods of cold weather with low ambient humidity.
• Trauma from being hit in the nose or due to a fall
• Insertion of a foreign body into the nose, such as beads, rubber erasers, paper wads, pebbles, marbles, beans, peas, nuts, sponges, or chalk.
• Exposure to pollution or fumes that cause nasal irritation, including tobacco smoke.

Other less common causes of nosebleeds are:
• Abnormal growths or structures inside of the nose, especially nasal polyps, the majority of which are benign.
• Abnormal blood clotting from medications like aspirin or in blood clotting disorders.
• Chronic illnesses requiring oxygen therapy due to drying and irritation.

Most nosebleeds do not indicate serious illness and can be managed safely at home. The following guidelines will help you control nosebleeding and determine when it is necessary to seek medical attention.

How to manage nosebleeds
1. Remain calm. Nosebleeds may be alarming but most often are not serious.
2. Have your child sit up or stand, lean forward, and spit out any blood that drains into the throat. Blood that is swallowed may irritate the stomach and cause vomiting.
3. Have your child gently blow his/her nose.
4. Tightly pinch the soft part of the nose (pinch just below the hard part) between you thumb and forefinger for 10 full minutes. Meanwhile have your child continue to breathe through the mouth. Do not release the pressure during those 10 minutes to check to see if the nose is still bleeding, as that may make it bleed more.
5. If bleeding continues after 10 minutes of continuous pressure, again squeeze for 10 full minutes.
6. If bleeding persists after 20 minutes of continuous pressure, resume squeezing and call your physician.

Common practices that are NOT helpful:
• Tilting the child’s head back
• Having the child lie down
• Applying a cold washcloth to the child’s forehead, neck, nose, or under the upper lip
• Pressing on the bony part of the nose
• Stuffing tissues or gauze or other objects into the nose to stop the bleeding

How to prevent nosebleeds
• Use a cool-mist humidifier in child’s room at nighttime
• Consider applying a small amount of petroleum jelly to the center wall inside the nose twice daily to reduce dryness and irritation.
• Use saline nasal spray (available over-the-counter) 2-4 times per day, especially during colds
• See your physician for treatment of nasal allergies to help reduce the itching/rubbing/bleeding cycle.
• Reduce nose picking. It may help to keep your child’s fingernails closely trimmed or to use thin cotton gloves or socks on your child’s hands at bedtime if your child picks his/her nose at night during sleep.
• Avoid excessive or overly-vigorous nose blowing.
• Avoid aspirin use unless directed to do so by a physician. Also some herbal medications such as ginkgo biloba may slow blood clotting and cause nosebleeds.

Call your child’s physician if:
• Bleeding does not stop after 20 minutes of direct pressure to the nose
• Your child is under 2 years of age
• You believe your child has lost a large amount of blood
• Blood is coming only from your child’s mouth, or he/she is coughing up or vomiting blood without a nosebleed.
• The drainage is foul-smelling (likely due to a nasal foreign body)
• She/he becomes pale, sweaty, unresponsive or has significant bruising
• Nosebleeds are prolonged, difficult-to-control, or continue to be a frequent problem

For further information, please visit the American Academy of Pediatrics website.

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