Q. My son got a nosebleed last week, and it really panicked us. What should we do next time he comes to us with a bloody nose?
A. A bleeding nose is a scary thing to see, but is almost never truly dangerous. The most common cause of bleeding is trauma, either external trauma like a ball hitting the nose, or more frequently trauma applied internally by a probing finger or a scratch on dried nose membranes.
If your child’s nose starts bleeding, first help him to not be scared or worried, and act calm even if you’re worried. Use your fingers or the child’s fingers to firmly squeeze the cartilage (lower) parts of the nose together—like you’re pinching your nose so you can’t smell something. You can hold the cartilage together just below the bony portion of the nose. You don’t need to tip your head back like you often see people do; this will just make blood run down your throat and can lead to vomiting or coughing. Hold the pressure for as long as you can reasonably stand it -- for very small kids it will be hard to do longer than 5 minutes even though some books say hold pressure for 20 minutes. This will almost always stop the bleeding.
If this doesn’t stop the bleeding, reapply the pressure there while calling your doctor. If the bleeding persists even after getting more advice, you may need to go to the emergency department, but this is extremely rare. If the bleeding doesn’t stop, the emergency department doctors or ear, nose, throat specialists may end up putting a packing into the nose.
If the bleeding is from a ball or something else hitting the nose, make sure that the nose appears straight and not broken. Also, after the bleeding stops you want to assure that the child can breathe through his nose and that there is not swelling in the middle part of the nose between the air holes, or the septum.
If the bleeding is from internal problems in the nose, the most common reason is a child picking his nose. This will often cause bleeding in the winter because the absolute amount of water and moisture in the cold air goes down, and then when that air is heated and expanded in houses the amount of moisture goes really low. A dry nose that bleeds frequently can be treated by taking a Q-Tip full of Vaseline each night and rubbing it around the inside of the nose up to about 1 centimeter deep (1/2 of an inch). In rare cases, nose bleeding can be a sign of a bleeding problem like low platelets or poor clotting.
Nose bleeds happen in almost all kids during childhood, and in most cases good moisturizing of the nose and short fingernails is the best prevention!
If you have a question about your child's health or happiness, ask Dr. Steiner or any of our experts by sending email to firstname.lastname@example.org.
Dr. Mike Steiner is a pediatrician in the division of General Pediatrics and Adolescent Medicine at UNC and North Carolina Children’s Hospital, a group of health-care professionals dedicated to improving the health of children and adolescents through clinical care, research, education and advocacy. The group includes over 35 physicians, practitioners, nurses and other health-care professionals. We supervise the care of children with general medical problems at N.C. Children’s Hospital, including hospitalized children, the newborn nursery, primary care clinic and a complex care and diagnostic clinic that also sees patients at the N.C. Children’s Specialty Clinic located on the Rex Healthcare campus in Raleigh.