Nosebleeds are common in school-aged children. There are many tiny blood vessels in the septum (cartilage structure that divided the nose into two sides) that may rupture without any apparent trauma and cause bleeding to occur from one or both sides of the nose. Nosebleeds can happen anywhere, at any time of the day or night.
There are many myths about how to treat nosebleeds, but here is what I recommend as a pediatric ENT specialist:
- Have your child lean forward and spit out any blood that drips into the back of the mouth. Don’t tilt the head back. Blood just runs backwards and may go into the back of the throat!
- While tilting forward, pinch the fleshy bottom part of the nose together tightly for 3-5 minutes. Three minutes may seem like an eternity, but the pressure being held for that long gives time for a tiny clot to form. Holding pressure higher on the nose does NOT help because that is not where the blood vessels are that typically bleed.
- If the bleeding has stopped after 3-5 minutes, your child may GENTLY blow their nose to clear any bigger clots after waiting 10 minutes. Don't blow the nose too hard for the next day or two.
- If the hand gets tired from squeezing tip of nose, then roll up toilet paper or a tissue and shove it gently up the bleeding nostril.
- Have your child sit still, breathe calmly, and relax the best he/she can, reassure the child.
- If the bleeding has not stopped after 10 minutes, you may use a few squirts of oxymetazoline (Afrin) nasal spray into the nose. You can also spray the rolled up tissue, and put that in the nostril. Afrin is a nasal decongestant that will usually cause the blood vessel to temporarily shrink and stop bleeding.
- If the bleeding is significant, consider going to a hospital Emergency Room, but this is incredibly rare.
- If your child has a known bleeding disorder that affects clotting, call your doctor and/or go to an ED.
Protecting the scabbed area is important to do for 1 week after a nosebleed:
- The area that bleeds is “raw”, so after an episode occurs, it’s common to have repeat episodes in the same day or several days in a row.
- After bleeding stops, please use topical triple antibiotic ointment such as Bacitracin or Neosporin. Apply some to your finger and wipe it in the front part of both sides of the nose opening 2-3 times a day for 1 week. This helps protect the tiny scab until the area can completely heal. People who don't do this tend to get repetitive nosebleeds from the same area because the scab dries out and comes off before the area is healed and the nose bleeds again.
- If the nose seems dry and your child rubs or picks it frequently, use a saline (salt water) mist or spray several times a day to moisturize the nose. This can be purchased at any drug store for a few dollars.
- If the nose bleeds repeatedly despite the above measures, an ENT specialist may choose to apply a special chemical (it looks like a cotton swab with some brown medicine on the tip called silver nitrate) to the area to cauterize a prominent blood vessel. This can be done after numbing the area to minimize discomfort, though there is a sensation of warmth when this is done. Not all children who get nosebleeds need their nasal septum vessels cauterized.
This short video provides more information on the control and prevention of nosebleeds:
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