Nose bleeding in children

Dr. Vijay Kundal
Nosebleed is also called epistaxis, can be quite dramatic and frightening. Luckily, most nosebleeds are not serious and can be handled fairly easily. Common in children ages 3 to 10 years. They are divided into two types, depending on whether the bleeding is coming from the anterior (front of the nose) or posterior (back of the nose). Anterior nosebleeds make up more than 90% of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor. Childen most commonly have anterior bleeds. Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital.
Causes of nose bleed
The most common cause of anterior nosebleeds is dry air. A dry climate air irritates and dries out nasal membranes, causing crusts that may itch and then bleed when scratched. Colds also irritates the lining of the nose, and bleeding can occur after repeated nose-blowing. An injury or blow to the nose can cause bleeding and usually is not a serious problem. Allergies also can cause problems, and medications such as antihistamines or decongestants given to control an itchy, runny, or stuffy nose. This can also dry out the nasal membranes and contribute to nosebleed. Nosebleeds are rarely cause for alarm, but frequent nosebleeds might indicate a more serious problem. If the child gets nosebleed more than once a week, one should consult the doctor. Less commonly, an underlying disease process, such as an inability of the blood to clot, may contribute to the bleeding. Inability of the blood to clot is most often due to blood-thinning drugs such as warfarin or aspirin. Liver disease can also interfere with blood clotting. Abnormal blood vessels or cancers in the nose are rare causes of nosebleeds. High blood pressure may contribute to nose bleeding.
Clinical presentation
Bleeding usually occurs from only one nostril. If the bleeding is heavy enough, the blood can fill up the nostril on the affected side and overflow within the nasopharynx, spilling into the other nostril to cause bleeding from both sides. Blood can also spill back into the throat or down into the stomach, causing a child to vomit blood. Signs of excessive blood loss include dizziness, light-headedness, confusion, and fainting. Excessive blood loss from nosebleeds does not often occur. Additional bleeding from other parts of the body, such as in the urine or bowels, or easy bruising may indicate an inability of the blood to clot and is considered a sign of some serious systemic problem.
What to do at home:
* Stay calm and reassure your child.
* With your child upright in a chair or in your lap, tilt his or her head slightly forward.
* Gently pinch the soft part of the nose (just below the bony ridge) with a tissue or clean cloth.
* Keep pressure on the nose for about 10 minutes; if you remove the pressure too soon, bleeding may start again.
* Do not allow your child lean back. This may cause blood to flow down the back of the throat, which tastes bad and can cause gagging, coughing, or vomiting.
* Have your child relax a while after a nosebleed.
* Discourage nose-blowing, picking, or rubbing.
* Spit out any blood in your mouth. Swallowing it may make you vomit.
When to seek routine consultation with doctor:
* Has frequent nosebleeds
* May have put something in his or her nose
* tends to bruise easily
* has heavy bleeding from minor wounds or bleeding from another place, such as the gums
* recently started taking new medicine
When to seek Emergency consultation with doctor/hospital:
* heavy bleeding, or is accompanied by weakness
* is the result of a fall or blow to the head
” continues after two attempts of applying pressure for 10 minutes each.
* having repeated episodes of nosebleeds over a short time.
* feeling dizzy or light-headed.
* having a rapid heartbeat or trouble breathing.
* coughing up or vomiting blood.
* having a rash or temperature greater than than 101.4°F.
Prevention of Nosebleed
* Keep child’s nails short to prevent injuries from nose-picking.
* Keep the inside of your child’s nose moist with saline nasal spray or dab antibiotic ointment gently around the opening of the nostrils.
* Humidify bedrooms with a vaporizer or humidifier.
* Make sure the child wear protective athletic equipment when participating in sports that could cause a nose injury.
Even when taking proper precautions, children can still get a bloody nose occasionally. So the next time your child gets a nosebleed, try not to panic. They’re usually harmless and are almost always easy to stop.
(The author is Consultant General & Pediatric Surgeon at Dayanand Medical College & Hospital, Ludhiana).