JOSEPH R. ANTICALIA MD
Medial Advisory Board
Nosebleeds (“epistaxis”) have been a bloody nuisance from the time of Hippocrates to the present. It’s a common problem that can occur at any time, in any place and in any season.
It’s most common in children from two to ten years of age and more frequent during the winter months. A blood vessel ruptures, the nose bleeds, parents are rightfully concerned and ready to rush the child to the emergency room.
Although epistaxis in children can be a signal of a serious problem and great anxiety to parents, the majority of the time it either stops on its own or can be treated with home remedies without the necessity to see a physician.
What Causes the Blood Vessel to Rupture?
There are many causes of nosebleeds, both local and systemic. It’s useful to know whether the bleeding is coming from the front or the back of the nose. In children, more often than not, it’s coming from the front of the nose. Some of the causes of nosebleeds are listed below:
- Nasal trauma — such as picking the nose, blows to the nose, and nasal fractures cause nosebleeds in children.
- Vigorous nose blowing
- Blood clotting disorders that run in families or those due to medications like aspirin.
- Allergies or an Upper Respiratory infection (URI) can increase the vascularity and crusting in the anterior part of the nose. The nose becomes stuffy, itchy and the child uses his finger to pick the nose initiating bleeding or the nose can bleed spontaneously.
- Foreign body reactions in the nose, a deviated nasal septum can also contribute to epistaxis.
- Much less commonly, certain blood disorders, nasal tumors (benign and malignant) and drugs beside aspirin can interfere with the clotting mechanism.
The majority of the time physicians cannot pinpoint a specific cause for the nosebleed.
“WHAT CAN PARENTS DO?”
Let’s start with a brief understanding of the parts of the nose you’ll be dealing with… When you feel the bridge of the child’s nose or your own nose and go down toward the tip of the nose, you’ll notice that the upper one third is bony hard and not moveable whereas the lower two thirds is cartilaginous, soft and moveable. The septum is a semi-rigid partition that separates the right from the left sides of the nose. It is made up of a delicate lining filled with blood vessels that cover the septum’s bone and cartilage. Here’s what to do:
- Place the child in a sitting position with the head and upper part of the body slightly leaning forward so that the blood doesn’t go down the back of the throat. Place a towel around his neck and shoulders and have a receptacle available for the child to spit into.
- If the child is old enough, instruct him to gently blow the nose to clear any clots. Remind your child to breathe through the mouth.
- Use your thumb and index finger to pinch all of the soft, lower two thirds of the nose for five minutes. If the nose is still bleeding, pinch the nose again for another five minutes. Often this is all that’s needed to stop the bleeding.
- If the above doesn’t work, saturate a piece of cotton about an inch and one half by one half inch with either neosynephrine or Afrin, the nasal decongestant spray. Insert the cotton into the anterior part of the nose and pinch it for another five minutes. You can repeat this once again.
- Restrict vigorous activity after the bleeding has stopped and avoid bending over. It takes time for the broken blood vessel to heal itself.
- You can put crushed ice in a small plastic bag and apply it to nose and cheeks.
- Call your doctor or go to the emergency room if the above does not control the nosebleed.
PREVENTION
- To combat nasal dryness and crusting one can use a saline nasal spray or apply a thin layer of petroleum jelly to the anterior nasal septum.
- Humidify the child’s home environment.
- Keep the child’s finger nails short.
- Control the home environment if the child is allergic.
- Seek medical advice to treat URI’s and other infections.
- Teach children to sneeze with their mouths open.
- Remind the child to blow the nose gently.
- Teach the youngster to pinch his nose so that he’ll know what to do if he experiences a nosebleed away from home.
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In short, hemorrhaging from the nose can be bloody frightening and serious. If your child has recurrent nosebleeds, gets a nosebleed after trauma or it takes a long time before the bleeding stops, or you have trouble stopping a nosebleed — do not hesitate to seek medical help.
For parents, the important thing to keep in mind is that — almost always — the bleeding comes from the front part of the nose, the problem is usually benign and more often than not, you can stop this kind of bleeding and prevent or minimize future episodes with home remedies.