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: Nosebleeds Are Common In Children

DEAR DR. PAUL: My 6 year old son keeps getting nose bleeds especially during the winter. They are easy to sop, but I am concerned. He is well otherwise. Could there be a problem?

PEDIATRICIAN DR. PAUL Answers: Thanks for your question, as this is a concern of many parents. Nosebleeds, medically know as "Epistaxis" are common in children and fortunately not usually associated with any serious underlying problem. Most of the time nosebleeds stop on their own without any specific treatment. With age the tendency for nosebleeds decreases.

What causes nosebleeds? An obvious cause is nasal trauma or injury, including picking the nose. We also know, like with your son, that the tendency to have nosebleeds increases during the winter months when the dry air irritates the inside lining of the nose resulting in bleeding. Interestingly, there seems to be a family tendency. In other words children with recurring nosebleeds often have relatives who have had the same. We also know that children with large adenoids, nasal allergies and chronic sinusitis tend to have more nosebleeds. High blood pressure (rare in children ) is also associated with a nosebleeds. In very rare circumstances, frequent or excessive nosebleeds may reflect a bleeding problem such as low platelet counts or lack of certain blood clotting factors (i.e. Hemophilia). In these cases there is a generalized bleeding tendency (cuts tend to bleed more than normal etc) making it relatively easy to distinguish a normal child form one who has a blood clotting problem. Again, let me reiterate, most children with Epistaxis are otherwise normal.

There are two aspects to treatment: Trying to stop a nosebleed and trying to prevent it. While most nosebleeds stop on their own within a few minutes, compressing or clamping the nose between the thumb and index finger will help. Contrary to what most people do, the head should be tilted forwards and not backwards. Tilting the head backwards will cause the blood trickle down the child's throat possibly resulting in coughing, choking or swallowing of the blood. In most children gentle nose compression or pressure will stop the bleeding easily. If the bleeding persists, medical attention should be sought as application of certain medications and/or inserting of nasal packing (cotton) gauzes will likely be needed. Certain children with recurrent nosebleeds may need an evaluation by an ENT doctor who will look for any bleeding site (a weekend blood vessel) and burn or cauterize it with silver nitrate application.

Prevention of nosebleeds is the other aspect of treatment. Obviously avoidance of trauma and wearing appropriate face protection during sports is important. Also, you should try to teach your kids not to pick their nose. During the winter months, make sure that the humidity in the house is adequate (about 40%). A humidifier can be used to bring the humidity up to this normal level. Another approach is to apply petroleum gel (Vaseline) or nasal saline lubricating gel into the nostrils at night. By keeping the inside lining of the nose moist, this treatment can also help prevent nosebleeds.

For more information on humidifiers go to:
DR.PAUL'S COLUMN ON HUMIDIFIERS


The information provided in this site is designed to be an educational aid only. It is not intended to replace the advice and care of your child's physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition, always consult a physician.

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