Winters in Jackson Hole mean lots of dry air, which is a main cause of nosebleeds in children.  In the following blog post, David Roberson, MD, FACS  from the General Pediatric Otolaryngology Program at Children’s Hospital Boston explains why they happen and the easiest way to treat them. -TR

Though they’re not usually a serious medical concern, nosebleeds in children can be scary. I witnessed this first hand recently when my 12-month old son hit his nose on the floor and burst into tears. I quickly examined him and told my wife that he would be fine. Just when everyone began to calm down, his nose began to bleed. “He’s bleeding,” my wife cried. “We have to take him to the doctor!”

Since I’m pediatric nose specialist at Children’s Hospital Boston I wasn’t exactly sure who my wife was in such a rush to see, but the worry in her voice made me understand just how scared parents get when their kids’ nose starts to bleed.

What causes nosebleeds? 

The inside of our noses is lined by mucosa—the same moist tissue that lines our mouth—and just like in our mouths, constant airflow around that mucosa can irritate it. If you clip your nose shut for an hour and breathe only through your mouth you’ll see why mucosa doesn’t like constant airflow—when it dries it cracks and eventually bleeds. Considering the fact that we breathe through our nose all day every day, it’s pretty remarkable that everyone isn’t walking around with constant nosebleeds. Amazing or not, the bottom line on nosebleeds in children is this: a drying of the nasal mucosa is the cause of almost all nosebleeds.

What do I do right after a nosebleed starts?

After a nosebleed starts, a lot of parents will grab an ice pack, cold towel, or start pinching the upper (bony) part of the child’s nose to try to get the bleeding to stop, but none of these things are helpful. It’s also not a good idea to put tissues or paper towels into a bleeding nose. The best thing to do is have your child lean forward and let the blood drip from his nose onto a towel. This won’t stop the bleeding, but it’s better for the blood to run outwards than down the back of his throat.

To stop the bleeding you need to apply pressure where the bleeding is happening, which is usually at the lower (cartilage) part of the nose below the nasal bone. Keep in mind that the goal isn’t to simply pinch the openings of the nose shut, because all that does is keep blood from running out. The real goal is to apply pressure on the bleeding vessel inside the nose. To do that, you need to compress the entire lower nose. Feel where the bone ends and squeeze the entire lower nose together, between your thumb and index finger. When done correctly, you will be squeezing right on the bleeding vessel itself, and in 95 percent of all cases firm pressure in that spot should be enough to stop the bleeding.  If your child has frequent nosebleeds, and you want to use this technique, practice it ahead of time on yourself and your child.

As long as you hold pressure on the entire lower nose, it won’t bleed. The problem is that when the nose is compressed your child has to breathe through her mouth. And because her nose is shut, breathing exclusively through the mouth will feel weird to her. (If you don’t believe me, try pinching you nose and breathing through the mouth for just a few minutes; it’s an odd sensation.) The child may complain about popping ears or a dry mouth, but let her know that if you let go too soon, the bleeding will start again.

Hold the lower nose closed for at least five minutes, though ten is better, and in most cases that will be enough time to let the blood clot. Parents with younger children will want to pinch the nose for them, but older children can be taught to hold pressure themselves. This can be a big help in managing a nosebleed at school or at another setting where it’s a social problem.

I have patients in my practice with bleeding disorders, platelet disorders, and all kinds of other blood related problems and it’s rare that any of them can’t control their bleeding with little more than some correctly applied pressure.

It’s not stopping and I’m starting to get nervous. What do I do next?

Try holding pressure for ten minutes. If that doesn’t work, try again for another ten minutes. If the nose continues to bleed, you should probably seek medical help. Call your pediatrician to see if an office visit would be better; but since most pediatricians’ offices aren’t equipped to manage major nosebleeds you may need to go to the Emergency Department.  If you have an ongoing relationship with an Otolaryngologist (Ear, Nose and Throat specialist) and can see them right away, that’s another good option.

Tips on staying cool and collected

Even the most poised mom or dad can get panicky when their child starts to bleed. It’s a fairly natural response, but in most cases it’s an over reaction and over reaction rarely helps us get over life’s minor speed bumps. The next time your child has a nosebleed, take a deep breath and remind yourself it’s probably nothing serious—and that it will most likely stop soon.

LINK(S):

Children’s Hospital Boston Thriving Blog