AAP PARENTING CORNER Q & A: NOSEBLEEDS

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Nosebleeds

My child gets a lot of nosebleeds. What should we do?

Your child is almost certain to have at least one nosebleed?and probably many?during these early years. Some preschoolers have several a week. This is neither abnormal nor dangerous, but it can be very frightening. If blood flows down from the back of the nose into the mouth and throat, your child may swallow a great deal of it, which in turn may cause vomiting.

Causes of nosebleeds

There are many causes of nosebleeds, most of which aren?t serious. Beginning with the most common, they include:

Colds and allergies: A cold or allergy causes swelling and irritation inside the nose and may lead to spontaneous bleeding.
Trauma: A child can get a nosebleed from picking his nose, or putting something into it, or just blowing it too hard. A nosebleed also can occur if he is hit in the nose by a ball or other object or falls and hits his nose.
Low humidity or irritating fumes: If your house is very dry, or if you live in a dry climate, the lining of your child?s nose may dry out, making it more likely to bleed. If he is frequently exposed to toxic fumes (fortunately, an unusual occurrence), they may cause nosebleeds, too.
Anatomical problems: Any abnormal structure inside the nose can lead to crusting and bleeding.
Abnormal growths: Any abnormal tissue growing in the nose may cause bleeding. Although most of these growths (usually polyps) are benign (not cancerous), they still should be treated promptly.
Abnormal blood clotting: Anything that interferes with blood clotting can lead to nosebleeds. Medications, even common ones like aspirin, can alter the bloodclotting mechanism just enough to cause bleeding. Blood diseases, such as hemophilia, also can provoke nosebleeds.
Chronic illness: Any child with a long-term illness, or who may require extra oxygen or other medication that can dry out or affect the lining of the nose, is likely to have nosebleeds.

Treatment

There are many misconceptions and folktales about how to treat nosebleeds. Here?s a list of dos and don?ts.

Do. . .

Remain calm. A nosebleed can be frightening, but is rarely serious.
Keep your child in a sitting or standing position. Tilt his head slightly forward. Have him gently blow his nose if he is old enough.
Pinch the lower half of your child?s nose (the soft part) between your thumb and finger and hold it firmly for a full ten minutes. If your child is old enough, he can do this himself. Don?t release the nose during this time to see if it is still bleeding.

Release the pressure after ten minutes and wait, keeping your child quiet. If the bleeding hasn?t stopped, repeat this step. If after ten more minutes of pressure the bleeding hasn?t stopped, call your pediatrician or go to the nearest emergency room.

Don?t . . .

Panic. You?ll just scare your child.
Have him lie down or tilt back his head.
Stuff tissues, gauze, or any other material into your child?s nose to stop the bleeding.

Also call your pediatrician if:

You think your child may have lost too much blood. (But keep in mind that the blood coming from the nose always looks like a lot.)
The bleeding is coming only from your child?s mouth, or he?s coughing or vomiting blood or brown material that looks like coffee grounds.
Your child is unusually pale or sweaty, or is not responsive. Call your pediatrician immediately in this case, and arrange to take your child to the emergency room.
He has a lot of nosebleeds, along with a chronically stuffy nose. This may mean he has a small, easily broken blood vessel in the nose or on the surface of the lining of the nose, or a growth in the nasal passages.

If your pediatrician sees your child during a nosebleed, she probably will repeat the nose-holding routine described in Step 3. (If the nose is full of blood clots, it may be suctioned clean first.) The doctor also may use nose drops that constrict the blood vessels, or put cotton soaked with medication inside the child?s nose. The doctor may decide to examine your child?s nose with a special light to find the origin of the bleeding. If a blood vessel is found to be causing the problem, the doctor will touch that point with a chemical substance (silver nitrate) to stop the bleeding.

If the bleeding still cannot be controlled, the nose may have to be packed with gauze. Your child won?t like this?it is uncomfortable? but it may be necessary. The packing is generally left in for at least twenty-four hours.

If your doctor thinks it?s necessary to explore the cause of the bleeding further or to make sure your child didn?t lose too much blood, a blood test will be ordered. It?s extremely rare that a child will need a blood transfusion to replace lost blood.

Prevention

If your child gets a lot of nosebleeds, ask your pediatrician about using salt-water (saline) nose drops every day. Doing so may be particularly helpful if you live in a very dry climate, or when the furnace is on. In addition, a humidifier or vaporizer will help maintain your home?s humidity at a level high enough to prevent nasal drying. Also tell your child not to pick his nose. If he picks it at night or in his sleep, put him to bed wearing thin cotton gloves or socks over his hands and pinned to his pajama sleeve.

Published online: 6/07

Source: Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2004 American Academy of Pediatrics, Updated 5/05)
To order a copy of this book visit the AAP Bookstore.
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The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

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