Dealing with nosebleeds in children

Girl controls nosebleed by pinching her nose.

Though they’re not usually a serious medical concern, nosebleeds in children can be frightening and socially disabling. Nosebleeds at school, friends’ houses or birthday parties can be quite disruptive, as many people are scared of blood and often nobody really knows what to do about it.

What causes nosebleeds? 

Almost all nosebleeds are caused by a drying of the nasal mucosa. 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 dry and irritate it.

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.

What should I do right after a nosebleed starts?

  1. 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 into the stomach, which will cause nausea and vomiting.
  2. Apply pressure where the bleeding is happening — almost always at the lower (cartilage or soft) part of the nose below the nasal bone. The goal is to apply pressure on the bleeding vessel inside the nose, not to simply pinch the openings of the nose shut. To do that, feel where the nasal bone ends and squeeze the entire lower nose together, between your thumb and index finger. You can practice this technique ahead of time on yourself and your child.
  3. When done correctly, firm pressure will almost always stop the bleeding. The problem is that when the nose is compressed, your child has to breathe exclusively through the mouth, which will feel weird to her. She 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.
  4. Hold the lower nose closed for at least five minutes — 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.

Many parents grab an ice pack or cold towel, or pinch the upper (bony) part of their child’s nose to try to get the bleeding to stop, but these things are not helpful. It’s also not a good idea to put tissues or paper towels into a bleeding nose.

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 still continues to bleed, you should seek medical help.

Call your pediatrician to see if an office visit would be better — but if they’re not equipped to manage major nosebleeds, they may suggest you go to the Emergency Department. If you have an ongoing relationship with an otolaryngologist (ear, nose and throat specialist) and can see one right away, that’s another good option.

What should I do if my child is having frequent recurrent nosebleeds?

For frequent and recurrent nosebleeds, it is a good idea to see an otolaryngologist. Some children benefit from cautery of prominent blood vessels — an in-office procedure that takes about 5 seconds and unfortunately, stings for up to a minute or two afterwards. Your physician needs to take a history and examine your child to determine what is best.

In very rare cases, a child may have a benign blood vessel growth, or possibly a clotting disorder. You don’t need to worry about either of these if your child has an occasional nosebleed. But if your child is having frequent, persistent, or worsening nosebleeds, you should have him evaluated by a physician.

What can I do to prevent nosebleeds?

  • Keep the interior of the nose moist by spraying over-the-counter saline into your child’s nose a couple of times daily.
  • Try a humidifier in your child’s room, especially in the winter when heating systems tend to dry out the air in your house.
  • Some children benefit from ongoing application of moisturizing agents to the nose. However, I wouldn’t advise you to do that unless your child has first been examined by a doctor.

Dr. David Roberson offers expert advice on treating and preventing nosebleeds in children.

The next time your child has a nosebleed, try not to panic. Take a deep breath and remind yourself it’s probably nothing more serious than some dry, irritated mucosa and it’s going to stop with a few minutes of pressure. The calmer you are, the calmer your child will be, and the easier managing the nosebleed will be for you both.

Dr. David Roberson is an otolaryngologist at Boston Children’s Hospital and an Associate Professor of Otology and Laryngology at Harvard Medical School.