Should Your Child See a Doctor?
This Care Guide Covers
- Bleeding from 1 or both nostrils
- Not caused by an injury
See Other Care Guide If
- After an injury. See NOSE 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.
When To Call Your Doctor
Call 911 Now (your child may need an ambulance) If
- Passed out (fainted) or too weak to stand
- You think your child has a life-threatening emergency
Go to ER Now If
- Bleeding a lot after 20 minutes of squeezing the nose correctly
Call Your Doctor Now (night or day) If
- 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 Your Doctor Within 24 Hours If
- You think your child needs to be seen, but the problem is not urgent.
Call Your Doctor During Weekday Office Hours If
- Age under 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
Parent Care at Home If
Care Advice for Nosebleed
- What You Should Know About Nosebleeds:
Squeeze the Lower Nose:
- 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.
Put Gauze Into the 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.
Prevent Recurrent Nosebleeds:
- If pressure alone fails, wet a gauze with a few decongestant nose drops. An example is Afrin. No prescription is needed. Insert the wet gauze into the side that is bleeding. Reason: The gauze helps to put pressure on the bleeding spot. The nose drops also shrink the blood vessels.
- If you don't have nose drops, use petroleum jelly (such as Vaseline). Put some on the gauze. Also, use petroleum jelly 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.
What to Expect:
- If the air in your home is dry, use a humidifier to keep the nose from drying out.
- Use a little petroleum jelly (such as Vaseline). Apply to the center wall of the nose. Do this twice a day to promote healing.
- 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.
Call Your Doctor If:
- 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.
- Can't stop bleeding with 10 minutes of direct pressure done correctly
- Your child becomes worse
Remember! Contact your doctor if your child develops any of the "When to Call" symptoms.
- Alvi A and Joyner-Triplett N. Acute epistaxis: How to spot the source and stop the flow. Postgrad Med. 1996;99:83-96.
- Guarisco JL and Graham III HD. Epistaxis in children: Causes, diagnosis and treatment. Ear Nose Throat J. 1989;68:522-538.
- McIntosh N, Mok J, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120 (5):1074-1078.
- Mulbury PE. Recurrent epistaxis. Pediatr Rev. 1991;12:213-216.
- Sharathkumar AA, Pipe SW. Bleeding disorders. Pediatr Rev. 2008;29 (4):121-129.
This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author: Barton D. Schmitt, M.D.
Last Reviewed: 1/2/2014
Last Revised: 4/4/2014 2:03:23 PM
Content Set: Child Symptom Checker
Version Year: 2014
Copyright 1994-2014 Barton D. Schmitt, M.D.