By Drs. Sally Robinson and Keith Bly
Many children get the occasional nosebleed. When it happens, it can be disturbing for both the parent and the child, because it seems as if a lot of blood has been lost. But if your child gets a nosebleed, it is important that you remain calm and try to keep your child calm. The amount of blood lost is usually minimal, and nosebleeds are not very serious.
The nasal membrane, or lining of the nose, keeps dust and other particles from going through the nose into the body. Nosebleeds occur when small blood vessels in the nasal membrane break. Unexpected nosebleeds can happen when the nasal membrane has been irritated by lots of sneezing, blowing or coughing due to allergies or a cold. They are also common in the winter, because heaters produce dry air that can cause the lining of the nose to dry out. Nose-picking can also break nasal blood vessels.
If your child gets a nosebleed, stay calm and try to calm your child. Have him or stand, leaning his head forward. Use tissues or a damp washcloth to catch the blood. Instruct the child to not lie down or tilt his head back, because these positions may cause him to swallow blood, leading to vomiting. Pinch the soft part of the nostrils for 10 minutes without letting go. This pressure on the blood vessels will allow the blood to thicken and form a scab. If the bleeding does not stop, try holding the nose for another 10 minutes.
There are some things that you can try to prevent frequent nosebleeds. First, remind your child to not pick her nose. When the lining of the nose dries out, it sometimes itches, and children pick their nose to get rid of this itchy feeling. You can apply a very small amount of petroleum jelly with a cotton swab or saline nose drops in each nostril to relieve the dryness. A humidifier may be useful to prevent dryness, but it may aggravate allergies.
If your child gets nosebleeds often and they are hard to stop, talk to your pediatrician. Nosebleeds are not normally serious, but if they occur frequently, your child's doctor may run some blood tests to see if her blood has trouble clotting.
Under the following circumstances, you should call your child's doctor or go to the emergency room:
- The bleeding lasts for more than 15 minutes after you have tried to stop it.
- Your child has lost a large amount of blood very quickly (more than about three teaspoons).
- You think your child has a broken nose.
- The bleeding is going down the back of the throat rather than coming out of the nose.
- Your child feels weak or ill.
- Your child is having trouble breathing.
- Your child is bleeding from other parts of the body, such as the gums or ears.
- The bleeding occurs three or more times in 24 hours.
- Your child has put something up his nose.
Dr. Sally Robinson is a pediatrician in the division of children's special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB. This column is not intended to replace the advice of a physician.
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