What You Need to Know about NosebleedsDr. Karen Sadler
Nosebleeds are common enough that not many of us escape childhood without experiencing a few. Usually, they aren’t a sign of a serious disease, though the sight of bright red blood seeming to pour out of a child’s nose is certainly alarming to most parents. Rare in infants, nosebleeds become more common in early- to mid-childhood, then become less frequent in the adolescent years. Overall, they occur more often in boys than girls.
The Anatomy of the Nose
Not only does the nose stick out of our faces (making it the first to be hit during a fall or fight) but it is loaded with blood vessels, two facts which predispose it as a common site of bleeding. In part, this allows the many functions of the nose: to warm, filter and humidify the air we breathe as well as enabling our sense of smell and contributing to the quality of our voices. Given the heavy supply of blood vessels and it’s vulnerable position on our faces, it’s not surprising that this is an area of the body that bleeds often.
There are two big issues around nosebleeds, especially frequent ones: Why are they happening and what can be done to control them?
Causes for Nosebleeds and Bleeding Patterns
Fortunately, most of the numerous possible causes for nosebleeds are not worrisome. Nosebleeds are rarely a sign of a serious problem such as a tumor or a bleeding disorder, including the blood cancer, leukemia.
Though there isn’t a foolproof way to decide which nosebleeds reflect a more serious disease (short of testing ordered by a physician), certain patterns of bleeding are more or less consistent with certain causes. Bleeding confined to just one side of the nose, for example, is more likely to result from local trauma (for example, nose-picking). In toddlers, the possibility that a small foreign object like a bead or crayon tip has been inserted into the nose should be considered. Trauma also tends to cause more sudden nosebleeds as blood vessels are burst open by the force of the trauma, rather than a slowly dripping pattern of bleeding.
Nosebleeds that come on more gradually, getting worse or more frequent with time, can be caused by a tumor within the nose, or an overuse of certain medicines such as Aspirin or Ibuprofen that interfere with the body’s ability to halt bleeding. Intermittent bleeding, especially in the cold weather months is a very common pattern. In this case, the many factors that irritate the lining of the nose, where the blood vessels are located, can bring on a bleed. Some examples include dry, heated indoor air, changes in the humidity, even changes in the weather. Add to this a bad cold, which winter inevitably brings, with irritating mucus, nose-blowing and rubbing, and there are even more reasons to suffer a nosebleed. It is also important to think about what nasal medications have been used, as chronic use of decongestants, steroids or cromolyn are associated with bleeding noses.
Other associated symptoms occurring with a nosebleed can narrow down the list of possible causes.
- Severe facial pain can point to a sinus infection, if there has been no recent trauma to explain it.
- Serious, frequent headaches accompanied by nosebleeds are seen with dangerously high blood pressure, although this is more often encountered in adults than in children.
- A strong family history of nosebleeds causes suspicion for a mild bleeding disorder such as Von Willibrand’s disease, which is passed down through the generations.
What to Do When Your Child’s Nose Is Bleeding?
Think of the “two Cs”: calmness and compression. Most nosebleeds are sudden and happen in fairly young children, who are frightened to have blood coming from their noses. Fortunately, most are also self-limited and stop after a few moments. The blood lost is usually minimal, though it looks like much more as it soaks a tissue.
To compress a bleeding nose, the first step is to have the child sit or stand. The head should not be tilted back as that allows blood to drip back into the throat, where it can be swallowed or gagged on. With a cold cloth or fingers, put light but steady pressure on the front part of the nose for five to ten minutes. Resist the temptation to check for continued bleeding after a few minutes, since it takes longer for some vessels to stop.
If after a full ten minutes the bleeding continues, repeat the compression and call a health care provider. Nothing should be put into the nose; steady pressure from the outside is the best strategy.
Although this rarely occurs with typical nosebleeds, worrisome signs that would merit immediate medical attention are a pale, sweaty or unresponsive child, one who vomits blood or who has suffered serious trauma to the nose or face.
This information is meant as a helpful, but general guide. It is best to bring frequent or worrisome nosebleeds to the attention of your child’s physician.