Nose bleeds/ Epistaxis

Nosebleeds are very common during childhood.  They are usually caused by trauma – rubbing or picking the nose, falling on the nose, sniffing or blowing the nose hard, etc.  Nosebleeds are also caused by dryness to the nasal lining.  All of these behaviors are increased in children with nasal allergies.

It is very common for a child to have another nosebleed in the hours to days following the first nosebleed.  The fragile scab that forms is easily disturbed, causing the nose to bleed again from the same spot. 

Some children have repeated nosebleeds from the same nostril over several weeks time.  This condition may be due to a small, fragile blood vessel that is too close to the surface and therefore easily damaged. 

Rarely, recurrent nosebleeds are caused by a bleeding problem. 

Do not be alarmed if after a nosebleed, a child may have bowel movements that contain bright red or black from swallowed blood.  Also, they may vomit swallowed blood. 

WHAT TO DO:

• Stop the nosebleed.  Calm your child and have her sit up andlean forwardso she doesn’t have to swallow the blood.  Initially, the child may spit out any blood in the mouth and blow the nose once to free any debris or large clots.  After this, donot have your child blow her nose.  Tightly pinch the soft parts of the nostrils together against the center wall (the same area you would hold if you were blowing the nose) for ten minutes.  Don’t release pressure for ten minutes.  Do not pinch the bridge of the nose. 
• Note:  Ice or a washcloth generally does not help a nosebleed.  Don’t pack anything into the nose at home because when it is removed, bleeding will recur.
• If nosebleeds are recurrent over several weeks, note if they occur on the right or left side (or both).
• Run a humidifier or put a small amount of petroleum jelly just inside each nostril.
• Treat nasal allergies.
• Discourage excessive blowing or picking the nose, as much as possible. 

WHEN TO CALL:

Call if fairly significant bleeding does not stop after 20 minutes of pressure. 

Call during office hours if nosebleeds are recurring over several weeks or for other unexplained signs of bruising or bleeding.