CAUSE:
There are many causes of nose bleeds.
- Trauma due to picking the nose is probably the number one cause. External trauma from a bump to the nose can cause a bleed.
- Dry air in the winter makes the nasal lining fragile and cause cause spontaneous nose bleeds.
- Allergies make the nasal lining swell and become fragile making it much easier for the nose to bleed. Strangely, some nasal steroid sprays meant to reduce that swelling of the nasal lining, can also lead to nose bleeds. Switching brand often fixes this.
- Rarely, there is simply a place on the nasal mucosa (lining) that will bleed on its own for now reason. In these cases, usually only one side of the nose bleeds frequently for no apparent reason.
I hesitate to mention this next cause for fear of making you worry. I have seen only a handful of children with this in 30 years, while a regular nose bleed is something we get called about several times per week. Extremely rarely, a child might have a blood clotting disorder making it hard for them to clot blood. These children usually have many other signs of this problem, such as prolonged time to stop bleeding from nicks, scratches and cuts, bleedings from the gums when brushing teeth, blood in the stool not due to a rectal tear or fissure.
TREATMENT:
There are usually 2 places the nose will bleed. The vase majority are right at the tip of the nose. Rarely, they are way back in the nose behind the bone you can feel that comes about half way down the nose.
First, let’s cover what not to do and what does not work. Don’t put anything inside the nose, like a tissue, unless we discussed this previously. This will only cause a clot to form on the tissue that will come off and re-bleed when you pull the tissue out. Putting the head forward or backwards does nothing to help the nose stop bleeding. Actually, if you put the head back and the blood goes inside and is swallowed, it is often very irritating to the stomach and might cause vomiting. Putting ice or a cool rag on the back of the neck does nothing to help a nose bleed either. It might calm the child down while you are giving the actual treatment. Putting your finger or a tissue under the nose does nothing to stop the bleed, but it will prevent the blood going all over the place.
HOW TO STOP IT:
- Pinch the nose shut at the end with firm pressure for 5 SOLID MINUTES WATCHING THE CLOCK. If the nose stops bleeding, then follow the prevention steps next.
- If the nose does not stop bleeding or restarts soon after you remove the pressure, then pinch the nose shut for another 5 or even 10 minutes. If the nose stops bleeding this time, then follow the prevention steps below.
- If the above to attempts do not stop the bleeding, then it’s time to pack things up and go to URGENT CARE or the EMERGENCY ROOM. There is most often a bleed farther up the nose that needs a nasal tampon to compress it. Very rarely, this can be a sign of a new onset clotting disorder. Continue to compress the nose while on the way to get treatment.
- If this is a frequent problem for your child and they are often hard to stop, you probably should at least call us or have an appointment to discuss. You may want to keep a hemostatic agent on hand. There are cotton nasal packing products with medicine on them that cause the blood to clot easier. There are too many generics to count. You may be able to buy these at local pharmacies or order on Amazon. Search nose bleed treatment and look for a cotton plug type product that mentions it has a clotting agent in it. Put these in the nose and pinch it shut when your child has a bleed. Some of these products are designed to be left in to dissolve. Some might require soaking with saline when you remove them to prevent pulling the clot off.
PREVENTION:
Once you get the nose to stop bleeding, let’s think about the possible causes and try to prevent those. If this is a one time nose bleed from a known traumatic cause, you most likely don’t have to do anything. If the nose bleeds keep happening, then it’s time for prevention.
- Check the fingers for telltale dried blood under the nails. If so, clip the nails short and instruct / command / request / cajole your child into not picking their nose to the point of causing a nose bleed.
- If its winter and the air is very dry, consider putting a humidifier in the child’s bedroom. Make sure to shut the door to let the humidity build up. 50-60% humidity is the goal. You can buy a cheap hygrometer (humidity meter) to help you reach that level. There are also humidifiers that you can set to automatically keep the humidity at any level you wish. MAKE SURE to follow directions and clean these correctly to prevent mold growth. There is a mold preventer that you can add to the water. WALMART, LOWES and HOME DEPOT have many models of humidifiers and the cleaner liquids.
- If the child has significant allergies, consider a nasal steroid such as Flonase. This will reduce the swelling in the nasal lining making it less fragile. It will take about 5-7 days to work. Nasal steroids also help the congestion, stuffiness, and coughing from allergies. Oral antihistamines, like Benadryl, loratadine, etc, tend not to really do much to prevent nose bleeds. Most children with allergies have seasonal allergies. Meaning they only occur for a 1-2 month period at the same time of the year. In these cases, once you start the nasal steroid, give it for about 2 months and then stop and see if the allergies have passed. It takes 5-7 days for the medicine to wear off. If your child has perennial allergies, this means they are year round and you might need to give this medicine continuously. We usually recommend stopping the medicine every month or two to see if this has improved.
- If your child has ongoing nose bleeds, most likely the nasal lining is dry and can use direct moisture. Get a nasal saline spray (Ocean Spray, Simply Saline, Ayr Spray, etc). Spray one spray up each nostril every hour WHILE AWAKE and WHILE NOT IN SCHOOL, until the nose bleeds have stopped for a few days.
WHEN TO SEEK CARE:
- If the above tips do not prevent frequent nose bleeds, call the office for advice or an appointment.
- If your child has other signs of clotting problems, such as: other injuries take a long time to heal, or other injuries are hard to get the bleeding to stop quickly, bleeding from gums when brushing teeth, blood mixed in the stool. Then call the office to discuss or make an appointment. If your child only recently started any of these issues, call immediately.
- If your child has excessive bruising: Now we are NOT talking about an active child whom has several normal bruises obtained from known normal causes. If your child looks like there were hit by a paintball machine gun, has dozens of unexplained bruises or bruises easily with the slightest pressure, then there might be a clotting disorder and you should call the office.
- If your child’s nose bleed does not stop after TWO 5-10 minute applications of pressure, then its time to go to the emergency room or urgent care.
