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Chronic Nosebleeds: What To Do and When To Seek Help

By Dr. David Darrow, Ear Nose and Throat Surgery

It can be alarming when your child gets a nosebleed, especially if it happens frequently. The good news is nosebleeds are common in kids and typically aren't cause for concern.

Causes of nosebleeds

In most cases, nosebleeds in children come from vessels that are in the front of the nose along the septum, the structure inside the nose that separates the two nostrils. The vessels are often prominent or fragile and can bleed when the nose is traumatized, inflamed, or excessively dry. Bleeding most commonly starts due to:

  • Colds, allergies, and excessive nose-blowing that irritate the septum.
  • Injury to the nose, which can be caused by anything from excessive nose-picking to hitting the nose during a fall or with an object.
  • Warm or dry air, especially in a home heated during the winter, can trigger nosebleeds by causing the vessels to expand or dry out.
  • Abnormal tissue in the nose can also cause a nosebleed. While most of these growths aren’t cancerous, they should still be evaluated.
  • Issues with blood clotting, which can occur due to common medication such as nasal sprays and ibuprofen, or in blood clotting diseases such as hemophilia.

Treatment for nosebleeds

There are many misconceptions about how best to manage nosebleeds. Here are some simple and safe rules to follow:

  • Keep calm and comfort your child.
  • Have your child sit up and keep the head in a neutral position. Tilting back may cause your child to swallow blood while tilting too far forward may worsen the bleeding.
  • Pressure on the bleeding vessel is the key to stopping the bleeding. Pinching the nostrils (the lower half of your child’s nose) and holding for 5 to 10 minutes is usually sufficient. If bleeding does not stop, place a piece of cotton moistened with a nasal decongestant (oxymetazoline) on the bleeding side and repeat the pinch for an additional 5 to 10 minutes.
  • Adding a cold compress on the bridge of your child’s nose may help constrict the blood vessels.
  • Repeat the steps above with a larger piece of cotton if bleeding does not stop.
  • Once the bleeding stops, make sure your child does not aggravate the nose by rubbing, picking, or blowing for two to three days.

If your child’s nose doesn’t stop bleeding, they should be seen by a healthcare provider.

When to call your child’s healthcare provider

While nosebleeds are rarely serious, some circumstances may require a call to your healthcare provider:

  • The nosebleed is not controlled after attempting treatment twice.
  • The nose bleeds repeatedly.
  • Your child has an injury to the head or face that also needs attention.
  • You think your child has lost a significant amount of blood.
  • Your child has frequent nosebleeds and a chronically stuffy nose, especially if only one side is blocked. This could indicate a growth in the nasal passages.
  • If your child feels ill, looks pale or sweaty, or has trouble breathing, you should take your child to the emergency room.

Prevention of nosebleeds

Considering most nosebleeds in children result from injury or dry air, there are some simple ways to prevent them:

  • Trim your child’s nails to ensure they are short enough to prevent injury from nose-picking.
  • Apply saline nasal gel or petroleum jelly inside the front of the nose to the septum to keep the surface moist.
  • Run a cool-mist humidifier if the air in your home is dry. However, make sure to maintain the cleanliness of the machine to prevent mildew buildup.
  • Keep kids safe with protective athletic equipment while participating in sports or other activities that could result in injury to the face or nose.

Even the most prepared and careful children can get the occasional bloody nose. The most important things to remember are to stay calm and take the necessary steps to stop the bleeding and prevent additional episodes.

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About Children's Specialty Group

About Children's  Specialty Group Children's Specialty Group is the only pediatric multi-specialty practice serving southeastern Virginia and northeastern North Carolina. The physicians of Children's Specialty Group base their practices at Children's Hospital of The King's Daughters and serve as faculty in the Department of Pediatrics at Eastern Virginia Medical School. Learn more about our specialists here.