Nosebleeds

DESCRIPTION

Nosebleeds (epistaxis) are very common throughout childhood. They are usually caused by dryness of the nasal lining plus the normal rubbing and picking that all children do when the nose is blocked or itchy. Vigorous nose blowing can also cause bleeding. Children who have nasal allergies are more likely to have nosebleeds because they rub and blow their noses more.

HOME CARE

1. Stopping the bleeding
   • Lean forward and spit out any blood. Have your child sit up and lean forward so he does not have to swallow the blood. Have a basin available so he can spit out any blood that drains into his throat. Swallowed blood is irritating to the stomach. Don't be surprised if it is vomited up.
     
   • Apply pressure by squeezing the soft part of the nose.
     
   • First your child should blow his nose to free any large clots that might interfere with applying pressure. Then tightly pinch the soft parts of the nose against the center wall for 10 minutes. Don't release the pressure until 10 minutes are up. If the bleeding continues, you may not be pressing on the right spot. During this time, your child will have to breathe through his mouth.
     
   • If bleeding continues, use vasoconstrictor nosedrops and squeeze again. Insert a gauze covered with vasoconstrictor nosedrops (for example, Neo- Synephrine) or petroleum jelly into the nostril. Squeeze again for 10 minutes. Leave the gauze in for another 10 minutes before you remove it. If bleeding persists, call your child's physician but continue the pressure in the meantime.
     
2. Prevention
   • A small amount of petroleum jelly applied twice a day to the center wall inside the nose (the septum) often helps relieve dryness and irritation.
     
   • Increasing the humidity in the room at night by using a humidifier may also be helpful.
     
   • Get your child into the habit of putting two or three drops of warm water in each nostril before blowing a stuffy nose.
     
   • Avoid aspirin. One aspirin can increase the tendency of the body to bleed easily for up to a week and can make nosebleeds last much longer.
     
   • If your child has nasal allergies, treating allergic symptoms with antihistamines will help break the itching-bleeding cycle.
     
3. Common mistakes in treating nosebleed
   • A cold washcloth applied to the forehead, bridge of the nose, back of the neck, or under the upper lip does not help stop nosebleeds.
     
   • Pressing on the bony part of the nose does not help stop nosebleeds.
     
   • Try to avoid packing the nose with anything because when it is removed, the nose usually starts bleeding again.

CALL US IMMEDIATELY IF:

• The bleeding does not stop after 20 minutes of direct pressure on the nose.

CALL US DURING OFFICE HOURS IF:

• Nosebleeds are a frequent problem even after petroleum jelly and humidification are used.
• You have other concerns or questions.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books., Edited by K. Abbott, M.D. for Springs Pediatrics.