Nosebleeds in Kids

Most nosebleeds in kids often happen near the front of the nose, and usually from just one nostril. Children may also get occasional or frequent nosebleeds. In rare cases, nosebleeds in kids begin at the back of the nose, which often happens in older adults with facial or nasal injuries and hypertension (high blood pressure). Frequent nosebleeds are usually caused by abnormal blood vessels and blood clotting problems. 

Read on to know the common causes of nosebleeds in kids, what you can do to treat them, and how to prevent them from occurring again. 

Causes

When the blood vessels that line the inside of the nose break and bleed, a nosebleed can happen. These blood vessels are also more prone to injury because they lie near the surface and are very fragile.

The following are some of the causes of nosebleeds in children:

• Foreign object in the nose: There are times when children try to experiment and place certain objects up their nose. If these objects can fit right into their nostril, they can become stuck. In an attempt to rid the stuck object, they try to push it up the nose and cause damage, which then leads to a nosebleed. 

• Nose picking: Nose picking, including blowing the nose too hard can cause a nosebleed. 

• Dry air: It makes the inside of the nose become itchy, cracked, and crusted. 

• Irritating fumes: Although unusual, children who are frequently exposed to toxic fumes may also get nosebleeds.

• Severe sneezing or coughing due to colds or allergies: Irritation and swelling inside the nose due to a cold or allergy may lead to nosebleeds. 

• Anatomical problems: Bleeding and crusting may occur when a child has an abnormal structure inside his/her nose. 

• Abnormal blood clotting: Blood clotting disorders can also cause nosebleeds. Hemophilia is a blood disorder, which can also trigger nosebleeds. Even medications, such as aspirin, can change the blood's clotting mechanism and cause bleeding, including nose bleeds. 

• Abnormal growths: Bleeding may also occur in children with abnormal tissues growing inside their nose. These growths are often benign, but must also be promptly treated. An example of these growths is a nasal polyp. 

• Chronic illness: Children with long-term illnesses, who take extra oxygen or medications for a longer period of time can have dry linings in their nasal passages and make them more prone to getting nosebleeds. 

In rare cases, nosebleeds can also happen when children have injuries outside of their head, face, or nose. When this happens, seek immediate medical attention. 

Categories of Nosebleeds

The two categories of nosebleeds are anterior and posterior nosebleeds. Anterior nosebleeds occur when there is bleeding in front of the nose while posterior nosebleeds occur from the back of the nose.

Their common symptoms often include:

• Anterior nosebleeds: Start with nosebleeding from one or both nostrils in either standing or sitting position.

• Posterior nosebleeds: Bleeding tends to start deep within the nose and down the back of the throat in either standing or sitting position. 

Recurring Nosebleeds

Some children may only have 1-2 nosebleeds over a certain period of time, but others tend to experience them more. Frequent nosebleeds can happen if there is constant irritation in the lining of the nose, which continues to expose the blood vessels that easily bleed. The nasal septum or the cartilage that separates the nose in half is the most common site of blood vessel injury.

How to Stop a Nosebleed

The following steps can generally slow down or stop nosebleeds in children:

• Apply direct pressure: Gently and carefully squeeze your child's nose using a clean cloth. Place a wad of moist cotton into the bleeding nostril and try to squeeze the nostrils together to apply pressure. When your child has a stubborn nosebleed, you can apply pressure and/or ice for as long as 10 minutes. Let your child breathe through his/her mouth. 

• Apply pressure to the nasal bridge: This can help decrease the flow of blood in the nose. 

For stubborn nosebleeds:

• Applying ice to the nasal bridge
• Tilting the head back
• Applying continuous direct pressure
• Application of an over-the-counter decongestant spray called Afrin nasal spray (helps shrink the blood vessels in your child's nose for 10 minutes)

The following remedies can help combat dryness in the lining of the nose:

• Vaporizer: Provides humidity in your child's bedroom to keep the air moist. 

• Saline nasal spray: Helps moisten the nasal passages. It can be used 2-3 times a day. 

• Antibiotic ointment: Heals exposed blood vessels on the nasal septum, including other sores inside the nose. Antibiotic ointments are both available as over-the-counter and prescription medications. 

• Emollient: Vaseline or lanolin ointment can be applied to help moisturize the inside of the nose. 

• Nasal cauterization: This procedure involves the use of a chemical or electrical device to the mucous membranes of the nose to stop stubborn nosebleeds. An ENT (ear-nose-throat) specialist usually performs this procedure. 

When to See a Doctor

Your child needs to see a doctor or visit the nearest emergency department if your child has any of the following signs and symptoms:

• Weakness
• Dizziness
• Feeling faint
• Sweaty, pale, or unresponsive
• Bleeding fast or when your child seems to be losing a lot of blood
• Unusual bruising
• Nosebleed with a severe headache
• Prolonged bleeding after getting injured
• Bleeding won't stop even after applying pressure for more than 10 minutes
• Bleeding on other areas of the body, such as your child's gums
• Recently started a new medication

How to Prevent a Nosebleed

You can ask your pediatrician about the daily use of saline (saltwater) nasal drops if your child easily gets nosebleeds, and if you live in a dry climate. Moreover, to help prevent nasal drying, use a vaporizer or humidifier to help keep your home at high humidity levels. 

Also, make sure to tell your child to avoid nose picking. Keep your child's fingernails clean and short to avoid tearing the blood vessels when he inevitably picks his nose. 

References

Nosebleeds. (January 2015). https://kidshealth.org/en/parents/nose-bleed.html

Nosebleeds in Children: Causes, Treatment, and Prevention. (May 2016) 

https://www.healthline.com/health/parenting/nosebleeds-in-children#1

Nosebleed (Epistaxis) in Children. 

https://www.hopkinsmedicine.org/healthlibrary/conditions/pediatrics/nosebleeds_90,P02055

Chronic Nosebleeds: What To Do. (6/1/2009). https://www.healthychildren.org/English/health-issues/conditions/ear-nose-throat/Pages/Chronic-Nosebleeds-What-To-Do.aspx