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Nosebleed

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Definition

  • Bleeding from 1 or both nostrils
  • Not caused by an injury

Causes of Nosebleeds

Nosebleeds are common because of the rich blood supply of the nose. Common causes include:

  • Spontaneous Nosebleed. Most nosebleeds start up without a known cause.
  • Rubbing. Rubbing or picking the nose is the most common known cause. It's hard to not touch or rub the nose.
  • Blowing. Blowing the nose too hard can cause a nose bleed.
  • Suctioning. Suctioning the nose can sometimes cause bleeding. This can happen if the suction tip is put in too far.
  • Sinus Infections. The main symptoms are lots of dry snot and a blocked nose. This leads to extra nose blowing and picking. The sinus infection is more often viral than bacterial.
  • Nose Allergies. The main symptom is a very itchy nose. This leads to extra rubbing and blowing.
  • Dry Air. Dryness of the nasal lining makes it more likely to bleed. In the winter, forced air heating often can dry out the nose.
  • Allergy Medicines. These help the nasal symptoms, but also dry out the nose.
  • Ibuprofen and Aspirin. These medicines increase the bleeding tendency. Aspirin is not used in children.
  • Bleeding Disorder (Serious). This means the blood platelets or clotting factors are missing or not working right. A bleeding disorder should be suspected if the nosebleed can't be stopped. Excessive bleeding from the gums or with minor cuts is also a clue. Bleeding disorders are a rare cause of frequent nosebleeds.
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When To Call

Call 911 Now

  • Passed out (fainted) or too weak to stand
  • You think your child has a life-threatening emergency

Go to ER Now

  • Bleeding a lot after 20 minutes of squeezing the nose correctly

Call Doctor or Seek Care Now

  • Nosebleed that won't stop after 10 minutes of squeezing the nose correctly
  • Large amount of blood has been lost
  • New skin bruises or bleeding gums not caused by an injury also present
  • High-risk child (such as with low platelets or other bleeding disorder)
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • Age less than 1 year old
  • New onset nosebleeds happen 3 or more times in a week
  • Hard-to-stop nosebleeds are a frequent problem
  • Easy bleeding is present in other family members
  • You have other questions or concerns

Self Care at Home

  • Mild nosebleed
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Care Advice

  1. What You Should Know About Nosebleeds:
    • Nosebleeds are common.
    • You should be able to stop the bleeding if you use the correct technique.
    • Here is some care advice that should help.
  2. Squeeze the Lower Nose:
    • Gently squeeze the soft parts of the lower nose together. Gently press them against the center wall for 10 minutes. This puts constant pressure on the bleeding point.
    • Use the thumb and index finger in a pinching manner.
    • If the bleeding continues, move your point of pressure.
    • Have your child sit up and breathe through the mouth during this procedure.
    • If rebleeds, use the same technique again.
  3. Put Gauze into the Nose:
    • If pressure alone fails, use a piece of gauze. Wet it with a few drops of water. Another option is to put a little petroleum jelly (such as Vaseline) on it.
    • Insert the wet gauze into the side that is bleeding. Press again for 10 minutes. Reason it works: the gauze puts more pressure on the bleeding spot.
    • Special nose drops: if your child has lots of nose bleeds, buy some decongestant nose drops. An example is Afrin. No prescription is needed. Put 3 drops on the gauze and press. The nose drops also shrink the blood vessels in the nose.
    • Caution: don't use decongestant nose drops if your child is under 1 year of age.
    • If you don't have gauze, use a piece of paper towel.
    • Repeat the process of gently squeezing the lower soft parts of the nose. Do this for 10 minutes.
  4. Prevent Recurrent Nosebleeds:
    • If the air in your home is dry, use a humidifier to keep the nose from drying out.
    • For nose blowing, blow gently.
    • For nose suctioning, don't put the suction tip very far inside. Also, move it gently.
    • Do not use aspirin and ibuprofen. Reason: Increases bleeding tendency.
    • Bleeding areas in the front of the nose sometimes develop a scab. It may heal slowly and re-bleed. If that happens to your child, try this tip. Apply a small amount of petroleum jelly (Vaseline) to the spot. Repeat twice a day. Do not use for more than 1 week.
  5. What to Expect:
    • Over 99% of nosebleeds will stop if you press on the right spot.
    • It may take 10 minutes of direct pressure.
    • After swallowing blood from a nosebleed, your child may vomit a little blood.
    • Your child may also pass a dark stool tomorrow from swallowed blood.
  6. Call Your Doctor If:
    • Can't stop bleeding with 10 minutes of direct pressure done correctly
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.
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