Nosebleeds in children occur so commonly that many parents know how to treat them at home. But what exactly causes a child’s nose to bleed?
When my daughter was three years old, she was in a Christmas program at her preschool. She was so excited to be up on stage and singing with her friends. All of the children were dressed in their adorable holiday outfits and sang their hearts out. The audience of parents chuckled occasionally as the little people did hand motions and sang words that were not in the script. The choir teacher appeared as if she were herding cats trying to keep everyone on task.
And then there was my child.
Singing her heart out, all while her finger was up her nose. At the age of three, she had no qualms about picking her nose in front of the large crowd of parents.
Nose picking is one of the most common reasons for nosebleeds in children, but it is not the only reason. In this article, we will look at the common causes of nosebleeds in children, how parents can treat their child’s nosebleed and when to seek medical help.
What is a Nosebleed?
A nosebleed is also known as epistaxis. Bleeding from the nose occurs when the delicate blood vessels that line the inner nose rupture. This leads to blood coming out of the nose and/or down the back of the throat. Posterior nosebleeds can cause your child to cough up or spit out blood from their mouth.
Bleeding from the nose can vary in severity. It can range from a few drops to a more significant amount of blood loss. While blood coming out of your child’s nose seems alarming, nosebleeds are typically not a cause for serious concern. Most of the time, this common ailment can be treated at home. For the majority of kids, their nose will stop bleeding pretty quickly with some simple maneuvers.
Picking Their Nose
Nosebleeds in children can occur for a variety of reasons, but nose picking is by far the most common cause. Sharp kid fingernails can do a lot of damage to the inside of the nose and lead to bleeding.
Often children will put their fingers in their nose if they have congestion, itchiness or feel like their nose is plugged by dried mucus. Repeated trauma to the inside of the nose, especially along the nasal septum where the blood vessels sit, lead to trauma and irritation. This can be especially problematic if a child already has dry nasal passages or if they have allergies or infections that make their blood vessels more fragile.
Kids don’t understand how delicate their nasal mucosa is. We, as parents, need to explain to them why picking their nose can cause broken blood vessels and nose bleeds. Children are especially at risk for recurrent nose bleeds if they have a blood clotting abnormality or are on blood thinners. Otherwise healthy children can also be at risk for recurrent nosebleeds if they have a habit of removing dried mucous from their nose with their tiny little fingers.
Dry Climates and Low Humidity
Dry climates are also common causes of nosebleeds in both children and adults. In areas with dry air, such as in the mountains of Colorado or New Mexico, the air is so dry that human skin and mucous membranes dry out too. I experience this every year when we travel from the humidity of north Texas to the dry desert air of New Mexico on our family vacations. Both my husband and I go through an entire tube of chap stick each for our lips and experience nose bleeds after hiking in the dry weather.
Another cause for dryness and thus nosebleeds is low humidity during the cold winter months. Dry and cold air can irritate the delicate blood vessels in the nose. Lack of moisture in the nasal mucus membranes irritate the tissues and lead to nose bleeds.
In order to prevent nosebleeds in these situations, it is important to keep the nasal passages moist.
- Use of a cool mist humidifier in your child’s room will add moisture to the air. This will help your child breathe easier by keeping the nasal membranes moist and thus less prone to bleeding.
- Additionally, you can apply a thin layer of petroleum jelly inside your child’s nostrils or have them do it themselves. This helps to retain moisture and protect the nasal lining from irritating dryness.
- Finally, encourage your child to drink plenty of water throughout the day. Staying well hydrated will help their body in many ways, including keeping their nasal cavity moist.
Allergic Rhinitis or Other Nasal Irritations
Allergies and other nasal irritants are also common causes of nosebleeds in children. Nasal allergies occur when the immune system overreacts to substances such as pollen, pet dander, or dust mites. Inflammation in the nose from this reaction causes nasal congestion, among other symptoms. As we know, when the delicate nasal mucosa is irritated, it is also more prone to bleed.
Sometimes nasal irritation from sinus infections can lead to a bloody nose as well. This is due to a similar mechanism as allergies. Only in this situation, the immune system is reacting to a virus or bacteria instead of an allergen.
Injuries to the Nose
Another somewhat obvious cause of nosebleeds are injuries to the nose. Kids are constantly pushing their limits and often this can result in an injury. Common injuries that may lead to nosebleeds include blunt trauma, such as from a fall or bumping into something, as well as sharp objects like pencils and sticks.
Nose injuries can range in severity from not so bad to heading to the emergency room. Depending on the mechanism, trauma can lead to minor bleeding vs more heavy bleeding. You can treat minor injuries to the nose at home with a few minutes of direct pressure to the area. If the bleeding stops, you can keep your child home and / or make a non-emergency visit with your pediatrician. However, if the bleeding is heavy or you can’t get it to stop, you should head to the nearest emergency room.
With heavy bleeding from either an injury or from the nasal surgery that may follow, nasal packing will be required to control the blood flow and minimize blood loss.
Foreign Bodies in the Nose
Another common cause of nose bleeding or nasal drainage in children is a foreign body. Children love to stick things up their nose. Foreign bodies can be anything from a small toy to a piece of food. Depending on the characteristics of the object, the resulting irritation can lead to bleeding from the nose.
In addition to bleeding, a foreign body may cause one sided discharge from a child’s nose. This finding on a physical exam will clue your pediatrician into a nasal foreign body. The drainage can be purulent (pus), bloody or both.
Often, your pediatrician can reach the item with a special type of forceps or grabber. Other times, the pediatrician will teach you the “mother’s kiss” technique to remove the item from the nose.
Treatment for Nose Bleeds in Children
.At-home treatment for nosebleeds in children should focus on providing comfort and preventing further injury. The first step is to have the child sit upright and lean forward slightly, so that any blood draining can avoid going down the throat and causing choking or vomiting.
Parents should apply pressure to the bridge of the nose for at least 10 minutes or until bleeding stops. Cold compresses or ice packs can also be applied to reduce swelling and relieve discomfort. If these measures do not stop the bleeding, it is important to consult a doctor as soon as possible.
If a nosebleed does not stop after 15 minutes of direct pressure or if it occurs with other symptoms such as fever, headache, dizziness, confusion, weakness or vomiting, it is important to seek medical attention immediately as this could indicate a more serious condition.
Frequent Nosebleeds
Frequent nosebleeds are defined as recurring nosebleeds that occur more than once a week. In these cases, further evaluation may be required to diagnose any underlying conditions contributing to the nosebleeds. Often, this involves a visit to a specialist or ear, nose and throat doctor.
An ENT surgeon can offer different treatment options to treat frequent nose bleeds in children. One of the procedures that they do frequently for this condition is cauterization of the blood vessels in the nose. This medical procedure involves carefully burning part of a tissue in order to stop bleeding. In the case of frequent nosebleeds, cauterization uses heat to seal off any blood vessels in the nose that are causing the bleeding.
Conclusion
Nosebleeds seem to be a rite of passage in childhood. Whether your child has an injury to their nose or allergies that cause them to itch and pick at their nose, bleeding is very common. Hopefully, after reading this article you will feel more confident on what to look out for, how to treat your child at home and when to seek medical care.
Remember, almost every child picks their nose at some point in their life, and this is by far th most common cause of bleeding.
If you are looking for a pediatrician that you can text a picture to and get a quick answer about your child’s nosebleed, join my practice.
© 127 Pediatrics; October 2023
This article exists for informational purposes only and should not be construed as medical advice.
Dr. Andrea Wadley is the owner, pediatrician, and breastfeeding medicine specialist for 127 Pediatrics. She has an established house-calls-only concierge pediatric practice in Colleyville, TX. She is also the owner and operator of the 127 Pediatrics Online Breastfeeding Medicine and Education Center.
