Ask a Doctor: Epistaxis in Children

Introducing: Ask a Doctor

At UTHSC ENT, we understand that patients need clear, helpful answers to their questions. We also know that a flood of new information can be overwhelming.

That’s why our department’s introducing Ask a Doctor: an ongoing series of posts that tackle Frequently Asked Questions about common issues. We hope these articles give you a better understanding of your situation and an easy path to treatment.

Today, our pediatric team discusses epistaxis.
Prepared by: Monica T. Ogunsusi M3, University of Tennessee College of Medicine
Reviewed by: Dr. Anthony Sheyn, Pediatric ENT specialist

First, what is epistaxis?

Nosebleeds are simply defined as any bleeding from the nose. The medical term for nosebleed is “epistaxis.” Epistaxis is common in children. Though frightening, nosebleeds are rarely severe and do not often require hospital admission.

Recently, we discussed how to stop a nosebleed, focusing primarily on adults. Here, we’ll outline epistaxis in children.

What causes nosebleeds in children?

Mucosal irritation and trauma are the most common causes of nosebleeds in children.

The inner nose is lined with a moist, thin layer of tissue called a mucous membrane. Because this layer is thin, it has very little protection for the blood vessels underneath. Anything that can cause irritation or inflict trauma on this thin membrane increases the likelihood of bleeding.

Recurrent nosebleeds are caused by many of the things above, however it can also be a presenting sign for an underlying condition, such as a bleeding disorder or blood vessel abnormalities.

Examples of Mucosal Irritation Trauma:

• Dry air
• Nose-picking
• Allergic rhinitis/congestion
• Foreign object inhaled
• Irritants/medicines
• Blunt or penetrating impact
• Upper respiratory infection to face blood vessels underneath

What should I do during a nosebleed?

The first step to stop a nosebleed is to control the bleeding.

1. Blow your nose. Bleeding may increase slightly for a moment and that’s fine.
2. Sit or stand while bending forward a little at the waist. Do NOT tilt head back or lie down.
3. Pinch the soft area towards the bottom of your nose, below the bone. Bleeding from the nose commonly comes from the blood vessels in this soft area. Pinching here helps slow bleeding.
4. Squeeze your nose for 5 minutes. Set a timer. It is important to NOT release pressure from the nose before the time is up. Stopping to check before the time is up can decrease the chances of the bleeding to stop. If the child is too young to reliably pinch their nose for the entire time, an adult should pinch the nose for the child.

If the child’s nose is still bleeding after these steps then repeat again.

When should I get help?

If after 10 minutes of pinching the nose, the bleeding does not stop, you may want to seek medical attention. Other symptoms that may prompt you to go the emergency department immediately include:

• Difficulty breathing
• Spitting or coughing up blood
• Pale appearance
• Tired or confused
• Nosebleed after a serious injury (car accident, hard hit to face, etc)

Epistaxis treatment and prevention

Treatments:
Medical professions use a variety of techniques to stop nosebleeds. After applying pressure to the nose, other options for controlling the bleeding include:

• Topical medicines. Applying medications like phenylephrine to the mucosal membrane of the nose can make the blood vessel small and slow the blood flow.
• Nasal packing
• Cautery. Chemical substances or small electric pulses can be placed in the nose to stop bleeding.
• Embolization. Doctors may use imaging to find the bleeding vessels and clot it off.

Prevention:
If you have recurrent nose bleeds, ways to reduce them include:

• Humidifiers to moisten the inner nose
• Nasal drops like saline drips or allergy sprays (if you have allergies)
• Discourage nose picking; clipping nails can help
• Prevent nasal trauma by wearing protective face gear when playing sports

Consult your doctor if your child has recurrent nose bleeds, bleeding gums, easy and frequent bruising to look for underlying causes.

How can our Dream Team help?

Our pediatric specialist, Dr. Anthony Sheyn, has wide-ranging expertise in treating children with ear, nose, and throat issues. If you have concerns about your child’s epistaxis, please contact our office to schedule an evaluation: 901-287-7337