Nosebleeds (Epistaxis)

Nosebleeds can be scary, but they’re usually not dangerous. Also known by the medical term epistaxis, a nosebleed is any loss of blood from the tissue in the nose. The front part of the nose contains many fragile blood vessels that can be damaged easily. Most nosebleeds in children occur in this area of the nose, close to the nostrils.

Nosebleeds are fairly common in children, especially in dry climates or during the winter months. Dry air and dry heat inside homes and buildings can cause drying, cracking or crusting inside the nose.

Often, children outgrow the tendency for nosebleeds during their teenage years.

Nosebleeds can be caused by many factors, but some of the most common include:

• Picking the nose
• Blowing the nose too hard
• Injury to the nose
• Dry air
• Colds and allergies
• A foreign body (or object that doesn’t belong) in the nose

Sometimes, no apparent cause for a nosebleed can be found.

To treat a nosebleed:

• Calm your child and let him or her know you can help.
• Have your child sit up and lean forward to avoid swallowing blood. Do not have him or her lie down or tilt head back.
• Pinch the nostrils together for five to 10 minutes without stopping to see if bleeding has stopped.
• If bleeding does not stop, try the above steps one more time.
• Do not pack your child's nose with tissues or gauze.

When to call your primary care provider

Sometimes, a nosebleed requires more than minor treatment at home. This can be determined by your child's primary care provider. In general, call your child's primary care provider for nosebleeds if:

• You are unable to stop the nosebleed or it recurs.
• Your child also has a nose injury that may indicate a more serious problem (such as a fractured nose or other trauma to the head).
• There is a large amount or rapid loss of blood.
• Your child feels faint, weak, ill, or has trouble breathing.
• Your child has bleeding from other parts of the body (such as in the stool, urine or gums) or bruises easily.
• A foreign body is stuck in your child's nose.

If your child has frequent nosebleeds, you can help prevent nosebleeds from occurring by:

• Using a cool mist humidifier in your child's room at night if the air in your home is dry. Be sure to follow the manufacturer's advice for cleaning the humidifier so that germs and mold do not grow in it.
• Teaching your child not to pick her nose or blow it too forcefully.
• Applying nasal saline gel, spray or drops (available over the counter in drugstores) inside the nostrils 2 to 3 times per day, especially at bedtime, to help keep the area moist.
• Antibiotic ointment applied into the nostrils with cotton swabs daily for 4 weeks if directed by your child's primary care provider. 
• Seeing your child's primary care provider for treatment of allergies that may contribute to frequent nosebleeds.

If your child continues to have repeated nosebleeds after completing preventative measures listed above, your primary care provider may refer you to a specialist.  The otolaryngologist (ear, nose and throat specialist) is generally recommended to manage and treat recurrent nosebleeds.  He or she may:

• Take a medical history, especially details surrounding when the nosebleeds occur and how you stop them.
• Conduct a physical exam.  Using a lighted instrument called a nasal speculum to inspect the nostril to look for signs of or causes of nosebleeds.
• Sometimes he or she will need to use a camera up into the nose to look a little further.
• Depending on the cause and severity of nosebleeds, a procedure called nasal cautery can be performed in the surgeon’s office or under general anesthesia to stop the bleeding from reoccurring.