Nosebleeds are common in children. The blood vessels in the nose are exposed to the outside environment, making them liable to rupture for numerous reasons. Though the bleeding may alarm parents, the amounts of blood lost are usually small and consequences of the occasional nosebleed are minimal. Minor cases of nosebleeding last for several minutes and are best treated symptomatically. As children grow into adolescence, nosebleeding becomes less of a problem. Frequent or persistent bleeds should prompt a visit to a physician.
Causes
Most nosebleeds have an unknown cause, but some cases are associated with excessive nose picking. Nosebleeding is more common in the winter, as dry climates make the blood vessels inside the nose more fragile and susceptible to rupture. Viral infections in the nose can lead to nosebleeds, as can the antihistamine decongestants that are commonly used to treat them. Foreign bodies such as marbles or coins placed inside the nose can cause persistent nosebleeding in younger children. When this occurs, the bleeding is often accompanied by a foul-smelling discharge.
Symptoms
In most cases, nosebleeds usually occur from only one side with a free flow of blood. If the bleed occurs in the back of the nose, or if it occurs while the child is sleeping, the blood may be swallowed and there may be no external bleed. In these cases, the blood may be seen only if the child vomits.
Treatment
For most nosebleeds, treatment is usually minimal. Firm pressure at the top of the nose should be applied for five to 10 minutes. An ice pack causes the vessels in the nose to constrict. A vasoconstrictor such as oxymetazoline may be applied in the form of nasal drops on the affected side; these also cause narrowing of the affected arteries. Most nosebleeds are minor and stop spontaneously within a few minutes.
Considerations
Children with massive nosebleeds should be taken to the emergency room for immediate treatment. An ear, nose and throat surgeon will evaluate the child for the source of bleeding and take measures to stop it. If a child has frequent nosebleeds, it may rarely be a sign of something more serious. These children should be evaluated by a doctor. Bleeding disorders and some leukemias may manifest as nosebleeds. Excessive bleeding in an adolescent male may be due to juvenile angiofibroma, a tumor within the nose. Inherited conditions such as hereditary hemorrhagic telangiectasia or cystic fibrosis may also cause recurrent nosebleeding in some children.
References
- "Pediatric Otolaryngology for the Clinician"; Ron B. Mitchell et al.; 2009
- "Nelson Textbook of Pediatrics, 18th Edition"; Robert M. Kliegman et al.; 2008
- Mescape; Epistaxis; Quoc A Nguyen; May 2011
