NOSEBLEEDS

Bloody noses in winter are common. The air is cold and dry, and kids can’t resist the urge to pick their little noses. Did you know that nose-picking (booger-hunting) is the #1 cause of “bloody noses” (a.k.a. epistaxis) in kids? And the index finger is usually the main culprit!

Many parents bring their children to the ER for nosebleeds, with concerns that their child might have a “bleeding disorder” or are now anemic after having lost so much blood. However, bleeding disorders are rare, particularly in children. Patients with bleeding disorders generally have other manifestations of bleeding such as easy bruising, frequently bleeding gums, and blood in their urine or stool.

Most patients do not need blood tests to check for anemia, even after a heavy nose bleed. If your child gets the occasional bloody nose, most can be managed at home, sparing you a trip to the ED.

TO STOP A NOSEBLEED:

  • When bleeding starts, grab some tissue and pinch the upper/middle portion of the nose, where the hard nasal bone turns to softer cartilage.

  • Squeeze firmly and hold constant pressure for 5-10 mins.

    • Do not let go to “check” to see if the bleeding has stopped. If you let go before the full 5-10 minutes, resume holding pressure over again.

PITFALLS:

  • Do not lean their head back, as kids can choke on the blood dripping back into their throat. Keep their head leaned forward to allow them spit out of their mouth as needed.

  • Do not use medicated nasal sprays such as Afrin® in children, as these can have dangerous side effects.

HELPFUL TIPS:

  • Once bleeding has stopped, allow the sensitive nasal passages to rest. Before bedtime, you can consider gently applying a vaseline-based ointment into the entry of the nostril for moisture.

  • The use of a humidifier in the room can also help prevent drying of these sensitive nasal membranes.

RED FLAGS TO GO TO THE ER:

Proceed to the ER, if your child has a massive nosebleed AND:

  • Has suffered an injury to his/her face.

  • Has massive bleeding that doesn’t stop despite constant pressure for 10 minutes.

  • Is taking a medication that is known to thin his/her blood.

  • Has had recent nasal/sinus surgery.

  • You are concerned that your child might have stuck something up their nose (i.e. nasal foreign body). Button batteries are particularly concerning. If you suspect your child placed a button battery up their nose, do NOT wait! This is a true medical emergency and you must go to the ER immediately.

Note: If your child has other signs of frequent bleeding (e.g. bleeding gums, easy bruising, recurrent epistaxis), talk to your pediatrician.             

*This is not a complete list of red flags. The information contained in this blog is not a substitute for professional medical advice, diagnosis, or treatment. If your child looks ill or you are concerned about their health, please seek immediate medical attention. When in doubt, call your child’s doctor, or go to the nearest Emergency Department.