Nosebleeds in Children

Nosebleeds can be scary, but usually cause no harm to children.

Children usually bleed from the superficial and thin blood vessels at the front portion of the nose on the septum, just behind the nostrils. Such nosebleeds usually decrease after puberty as the nose lining thickens from hormonal changes.

The most common causes of nosebleeds are:

• Nose-picking – this may also increase the frequency of nosebleeds
• Allergies
• Colds
• Injuries
• Irritation from dry or cold air

In rare instances, bleeding disorders or nasal tumours may cause nosebleeds.

Self-care measures

With the right self-care, most nosebleeds will stop on their own. When a child’s nose bleeds, ask him to sit up, lean forward and pinch the lower soft portion of the nostrils together for 5 to 10 minutes, and breathe through the mouth.

An ice pack can be placed across the nose-bridge and forehead or the cheek to allow for reflex constriction of the tiny blood vessels. The majority of nose bleeding stops during this time. If bleeding starts again, compression can be applied for another 10 minutes.

Sitting upright keeps the nose higher than the heart, and reduces the flow of blood to the bleeding site. Leaning forward prevents your child from swallowing blood that could result in vomiting and other uncomfortable symptoms.

When to seek emergency medical care

You should seek emergency medical care if your child’s nosebleed:

• Involves massive bleeding or makes breathing difficult
• Causes your child to become pale, fatigued and disorientated
• Will not stop even with the selfcare measures outlined above
• Occurs after an injury, such as after being hit on the face or nose
• Will not stop and your child has other areas of bleeding or multiple bruising over his body

When to seek ENT specialist treatment

If your child’s nose bleeds only once in a few months it is not likely to be of serious concern. However, if it is a regular occurrence i.e. 4 to 5 times a month, your child should be reviewed by a specialist to rule out rarer causes of nosebleeds.

The ENT surgeon can check the nose for growths or abnormal blood vessel formations. Another explanation for one-sided nosebleeds or odorous nasal discharge in a child is the presence of a foreign body. When examining children with frequent unexplained nosebleeds, ENT surgeons often discover beads, rubber erasers or toys lodged deep in the nose.

Other measures

A humidifier can be used to reduce the drying caused by air-conditioning as it may not be practical to avoid sleeping in an air-conditioned room in Singapore’s warm equatorial climate.

Advise your child against frequent nose-picking to prevent trauma to the affected area.

If all these measures fail, consult an ENT surgeon who may cauterise (seal off ) the affected area with diathermy (a procedure using an electric current, usually done under general anaesthesia).

If the child refrains from nose-picking and other predisposing factors are removed, this procedure usually allows for 6 months to a year of relief from symptoms.