NOSEBLEEDS

Introduction

Bleeding from the nose most commonly occurs when tiny blood vessels inside the nostrils are ruptured, either by a blow to the nose, or as a result of sneezing, picking or blowing the nose. Nosebleeds may also occur as a result of high blood pressure.
A nosebleed can be dangerous if the casualty loses a lot of blood. In addition, if bleeding follows a head injury, the blood may appear thin and watery. The latter is a very serious sign because it indicates that the skull is fractured and fluid is leaking from around the brain.

Your Goal

• To control blood loss.
• To maintain an open airway.

Treatment

• Ask the person to sit down.
• Advise them to tilt their head forwards to allow the blood to drain from the nostrils.
• Ask the person to breath through their mouth (this will also have a calming effect) and to pinch the soft part of the nose.
• Reassure and help if necessary.
• Tell the person to keep pinching their nose.
• Advise them not to speak, swallow, cough, spit or sniff because this may disturb blood clots that may have formed in the nose.
• After 10 minutes, tell the person to release the pressure. If the bleeding has not stopped, tell her to reapply the pressure for two further periods of 10 minutes.
• Once the bleeding has stopped and with the person still leaning forwards, clean around their nose with lukewarm water.
• Advise the person to rest quietly for a few hours. Tell them to avoid exertion and in particular, not to blow their nose, because these actions will disturb any clots.

CAUTION:

• Do not let the head tip back; blood may run down the throat inducing vomiting.
• If bleeding stops and then restarts, tell the person to reapply pressure.
• If the nosebleed is severe, or if it lasts longer than 30 minutes in total, take or send the person to hospital in the treatment position.

Although they can be scary, nosebleeds are rarely cause for alarm. Common in kids ages 3 to 10 years, nosebleeds often stop on their own and can be treated safely at home.
What to Do:

• Stay calm and reassure your child.
• Sit your child upright in a chair or in your lap and have your child tilt his or her head slightly forward.
• Gently pinch your child's nose (just below the bony ridge) with a tissue or clean washcloth.
• Keep pressure on your child's nose for about 10 minutes; if you stop too soon, bleeding may start again. It may also help to apply ice wrapped in a paper towel.
• Do not have your child lean back. This may cause blood to flow down the back of the throat, which tastes bad and may initiate gagging, coughing, or vomiting.
• Have your child to rest for a while after a nosebleed. Discourage blowing, picking, rubbing, and any rough play.

Call your child's doctor if your child:

• has frequent nosebleeds
• may have put something in his or her nose
• tends to bruise easily
• has heavy bleeding from minor wounds or bleeding from another place, such as the gums
• recently started taking new medicine

Seek emergency medical care or call your child's doctor if bleeding:

• is heavy, or is accompanied by dizziness or weakness
• is the result of a fall or blow to the head
• continues after two attempts of applying pressure for 10 minutes each

Preventing Future Nosebleeds
Most nosebleeds are caused by zealous blowing or picking, or a blow to the nose during rough play. In the wintertime, especially, if your child's bed is near a heater, the membranes inside the nose can become dried and itchy, causing your child to pick at his or her nose and further irritate the nasal tissue. Colds, other viruses, and allergies may also irritate the lining of the nose.
To help prevent your child from getting nosebleeds:

• Keep your child's nails short to prevent picking.
• Keep the inside of your child's nose moist with saline nasal spray or dab petroleum jelly gently around the opening of the nostrils.
• Humidify your child's room with a vaporizer (or humidifier) if the air in your home is dry. You can buy a cool mist or hot steam (also called warm mist) model. If you go with the hot steam kind, make sure to keep it out of your child's reach to avoid scalding. It's also important to keep vaporizers clean to prevent mildew.
• Make sure your child wears protective athletic equipment when participating in sports that could cause injury to the nose.

Even when taking proper precautions, your child may still get a bloody nose occasionally. But the next time your child gets a nosebleed, try not to panic. They're usually harmless and are almost always easy to stop.

Disclaimer: This information is not intended 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.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: December 2004