Check-up: My child's nosebleeds are frightening

July 23, 2018

Dear Readers,

Chevaughn is 34 years old, and emails Check Up asking about nose-bleeds. He notices that his five-year-old son tends to have them a lot.

Well, nosebleeds in children can make us very anxious, but mostly they are not serious. While nosebleeds in infants are unusual and need further investigation, nosebleeds in older children can occur spontaneously, and for a time, may even occur frequently.

Children who pick their nostrils frequently may suffer with frequent nosebleeds, and this is a habit which needs to be discouraged. Children also sometimes push foreign objects up their nostrils without anyone knowing. This can also cause a nosebleed and also a bad smelly nasal discharge if the object in the nostril is a pea or rice grain. If the anterior chamber of the nose is very dry, nasal bleeding can also occur. This can sometimes happen with overuse of nose drops or with exposure to very dry air.

Less common causes of nosebleeds would include leukaemia, which is a blood cancer; nasal tumours or cancers; kidney disorders; bleeding disorders such as haemophilia; and blood-clotting abnormalities or accidental ingestion of blood thinning medications. When nosebleeds recur frequently, it's always a good idea to check the situation out with a doctor.

Bleeding usually occurs from one nostril only, although if the bleed is heavy, it can overflow into the space behind the affected nostril and down into the other nostril, also resulting in blood flowing from both nostrils. If bleeding is heavy, blood can also run into the stomach and the child can vomit blood

Signs of excessive blood loss will include weakness, dizziness, fainting and confusion.

However, you should contact your doctor if:

- There are repeated episodes of nosebleeds.

- If bleeding is also occurring from other sites in the body or there are signs of easy bruising, please do not hesitate to see a physician immediately.

- Children who have had recent chemotherapy treatment may also experience nosebleeds, but those are easily understood as the cause is obvious.

Sometimes a small amount of blood is seen when allergic rhinitis is present and sneezing occurs. There is no need to worry over this small bleed. It is due to irritation and breakage of a small blood vessel due to forceful sneezing. Just avoid forceful blowing or sneezing.

To stop a nosebleed, the child should be made to sit upright and lean forward slightly, tilting the head forward to allow blood to drain out (and not go down to the throat and stomach). Then, pinch the nose firmly for 10 minutes while the head is angled forward, and allow the child to spit out any blood which runs back into the mouth.

This will stop most nose-bleeds. If bleeding continues, then continue to pinch the nose shut while adding an ice pack. If this doesn't work, it's time to head for your doctor or the Accident and Emergency Department at a hospital where they may pack the nostrils to apply direct pressure to the bleeding vessels.

After a nosebleed, it's a good idea to avoid coughing or sneezing, so medication may be required. Also, non-steroidal anti-inflammatory drugs such as Advil or Cataflam or Brufen should be avoided for their potential blood-thinning effect, which could contribute to new bleeding.

To prevent most nosebleeds in children, try to prevent them from nose-picking.

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