Nosebleeds: Overview

September 06, 2008

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Nosebleeds: Overview

by Lynn Cates, M.D., F.A.A.P.
reviewed by Robert Needlman, M.D., F.A.A.P.

Nosebleeds can be a nuisance, but they rarely are serious. Since almost all children get nosebleeds at least occasionally, it's a good idea for parents to know something about them.

What causes nosebleeds?
Nosebleeds occur when the protective lining of the nose is injured, dry, or irritated. Most often, they are just due to a child's picking, rubbing, or blowing her nose. Of course, they are also common after a blow to the nose (e.g., if someone punches her in the nose or if she falls and lands on her face). Breathing dry air (e.g., forced air heating in winter or arid climates) predisposes everyone to nosebleeds because it dries out the normally moist lining (also known as mucous membranes) of the nose. When this lining is dry, it can't protect the blood vessels of the nose as effectively.

Nosebleeds tend to occur more frequently when a child has a persistent runny nose (e.g., hay fever, a cold, or sinusitis) because this can irritate the lining of the nose--whether or not she blows it energetically.

Less often, nosebleeds can be caused by some medicines, such as aspirin, or underlying medical conditions that cause problems with bleeding. Occasionally a nosebleed is the result of child's sticking a foreign object up her nose.

What can parents do to help?

Stay calm. Although many children and parents take nosebleeds in stride, the sight of blood can really bother others. Remember that a child with a nosebleed may be feeling frightened, worried, or even guilty depending on the circumstances that led to the nosebleed. It's important for you to stay calm and to reassure your child that she will be just fine.

Get comfortable.

Apply pressure. There is no reason to be confused about what to do for a nosebleed because it makes so much sense. The vast majority of nosebleeds can be stopped simply by pinching the nostrils shut, applying gentle but firm pressure to the fleshy part of the nose. The hard part is getting your child to hold still while you apply the pressure for a full 10 minutes. (Since 10 minutes can seem like a very long time, time yourself with a clock if possible.)

If you have someone else who can help you, it's a good idea to have him bring you a storybook to read so your child has something to keep her mind occupied. If you are alone with her, you can always make up silly stories or sing favorite songs. You also may want to promise her a small treat for being a good girl. If she is old enough, she may prefer to hold her nose herself. Make it a point to stay with her to be sure that she maintains pressure for the entire 10 minutes.

Insert a plug. Many experts feel that it is safer if parents do not try to insert anything into the nose to help stop the bleeding. Some practitioners, however, think it is OK to place a cotton or gauze plug into the affected nostril. This plug should be moistened with water or coated with petroleum jelly. In older children, you might try a few drops of Neosynephrine nose spray.

If you do insert anything into your child's nose, use a large enough plug so that it doesn't get stuck way inside and doesn't pose a choking hazard if it comes out. Also, don't forget to remove the plug--a few minutes later in infants and up to a few hours in older children.

The two main disadvantages of putting anything into your child's nose are the risk of choking and the tendency for the nosebleed to start up again when the plug is removed because it may dislodge the clot.

Calling for help
For information about when to call for professional help with your child's nosebleed, see our article "Nosebleeds: When to Seek Help."

What not to do
Here are some things that don't work for a nosebleed.

Putting ice or a cold washcloth on the nose or anywhere on neck (for some reason, the back of the neck is a common favorite).

Tilting a child's head back. This can cause choking or coughing, which may exacerbate the nosebleed. It also may make her swallow the blood and cause her to vomit.

How to clean up
Most parents don't like to see blood on their child's face. But after a nosebleed, it's not a good idea to vigorously scrub her nose because the bleeding may start again. It's fine to gently wash the rest of her face, but it is better to wait a few hours to gently cleanse the nose itself.

To prevent permanent stains on your child's clothing or pillowcase, your towels, and anything else she may have bled on, just soak the items in cold tap water and gently rub the spots until they disappear. Sometimes this requires soaking overnight. Once the soiled articles have gone through the wash and dry cycles, the stains will set and be much harder to remove.


RELATED INFORMATION

			Nosebleeds: When to Seek Help
			Preventing Nosebleeds
			Symptoms & Conditions
			Nose and Sinus Problems

Injuries and First Aid

Created December 07, 2001
Reviewed December 10, 2001

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