Most epistaxis in children is minor and tends to self-resolve without any intervention other than direct pressure at the tip of the nose (the lower soft part of the nose). This can be performed by a parent or carer. In the event of a nosebleed, I advise that you:
- Calm and comfort your child.
- Have your child sit up and lean forward slightly.
- Don’t have your child lie down to prevent him or her from swallowing blood. Swallowing blood may make your child vomit.
- Tell your child to breathe out of his or her mouth.
- Gently pinch the nostrils closed for 10 to 15 minutes.
- Don’t stop pinching to check if bleeding has stopped.
- Apply a cold compress to the bridge of the nose.
- Don’t put tissues or gauze in your child’s nose.
- Once the bleeding stops, tell your child not to rub, pick, or blow his or her nose for two to three days. This will let the broken blood vessel heal.
If your child’s nose bleed seems excessive, swallowing a large amount of blood, the bleeding started after a blow to the head, feeling weak or dizzy and/or having difficulty breathing, then please take your child to the nearest A&E.
What are the treatment options for nosebleeds in children?
The possible treatment options depend on the severity of your child’s nosebleed, but may involve the following:
The majority of times, nosebleeds in children can be stopped by applying pressure to the lower soft part of the nose for 10 to 15 minutes. A cream called Naseptin is applied twice daily for the next two weeks. This cream helps the broken vessel to heal fast and also makes the bleeding area moist so that it doesn’t get crusted. It is the falling of crust that results in bleeding. Naseptin cream cannot be used in children who are allergic to peanuts as it contains peanut oil. In that case, they have to use Bactroban ointment.
If the bleeding is uncontrolled and not stopping inspired by the above measures, the child has to be seen in A&E. Here they might perform a procedure called cauterisation (applying chemical silver nitrate sticks) to the broken blood vessel. Rarely children require nose packs. Blood tests including full blood count and coagulation studies are usually performed.
The ENT doctor will examine the child’s nose looking for any potential bleeding areas. This is usually found in the front part of the nose on the nasal septum (which is known as ‘Little’s area’).
If the obvious cause is not found then the ENT doctor might carry out an endoscopic examination of the nose to look for other causes. Most of the nose bleeds in children are managed conservatively that is by applying pressure to the soft part of the nose, base-tin cream application etc. We tend to avoid cauterisation in children according to NICE guidelines.
How can I help prevent a nosebleed in my child?
If your child has nosebleeds often, you can help prevent them in these ways:
- Teach your child not to pick his or her nose or blow it too hard.
- If the bedroom is too dry, then using a humidifier helps to moisten the nose and thereby prevent crusting as it is the decrusting (picking nose/sneezing/rubbing the nose) that results in the crust to peel off from the nasal mucosa which in-turn cracks the small blood vessels.
- Using saline nose drops can also help in softening the crusts.
- Apply Naseptin cream to the front part of the nose (Little's area) twice daily for two weeks. This can be repeated for future nose bleeds. Please bear in mind again that Naseptin cream contains peanut oil. If your child is allergic, this should be avoided and the alternative is Bactroban cream.
- Apply this to the front part of the nose with clean hands without touching the Littles area. Pinch the front part of the nose so that the cream smears the Littles area on both sides.