The children’s and young people’s diabetes team
Nosebleeds are very common, particularly in young in children, and most children will be affected by them at some point.
Most nosebleeds will settle on their own with ﬁrst aid and without any need for medical treatment. Nosebleeds can be messy and even scary, but often look worse than
What causes nosebleeds?
A nosebleed (also called epistaxis) happens when a blood vessel in the lining of the nose bursts. This damaged blood vessel may then bleed on and off for a few weeks before healing so it is common for nosebleeds to come in clusters and settle in between.
Nosebleeds are most commonly due to the lining of the nose “drying out” which may lead to crusting and bleeding. Harmless activities such as nose picking, blowing it too hard, rubbing the nose, or a slight knock may cause the bleeding to start.
Some other causes of a nosebleed include:
- Infections in the nose for example; common cold
- Allergies, for example; hayfever
- Foreign body in the nose for example; when a child has pushed something up their nose
- Constipation for example; straining on the toilet
- Underlying medical problem – this is very uncommon
First aid for nosebleeds
- Try to keep your child calm as they may get upset by the sight and taste of the blood.
- Sit them upright in a comfortable position with the head tilted forwards.
- Squeeze the lower, soft part of the nose pressing the nostrils together. An older child may be able to do this themselves. Keep squeezing for 10 minutes.
- Do not keep removing your ﬁngers to check if the bleeding has stopped. This is one of the commonest reasons for the nosebleed to continue.
- If the bleeding continues squeeze the nose again for a further 10 to 15 minutes.
- Avoid putting tissue paper or other objects up the nose to try to stop it, pressure to the right area is the best treatment.
- Reading a book can help distract your child and it is a good idea to use your watch or a clock to check the time.
In rare cases where the bleeding continues for more than 30 minutes consider attending an emergency department.
After the nosebleed stops
Once the nosebleed has stopped it is important that your child rests for a couple of hours and avoids hot drinks and foods for the next 24 hours.
For the next 10 days hot showers or baths, spicy foods, exertion and heavy exercise should be avoided. All of these things will increase the blood ﬂow to the nose and make it more likely to bleed.
How can nosebleeds be prevented?
Try to stop your child from picking their nose and keep their ﬁngernails short.
If your child suffers from constipation increase their ﬂuid and ﬁbre intake and see your GP for advice about a stool softener.
Consider applying a petroleum-based ointment such as Vaseline to the middle partition of the nose twice a day for a month. This can be done using your ﬁnger and helps stop the lining of the nose drying out.
What treatments can be given for ongoing nosebleeds?
In most cases no further treatment is needed and it is important to remember that it is not uncommon to get repeated nosebleeds.
If a nosebleed has not settled in 30 minutes of continuous pressure your child will need to be examined by a doctor and you should consider taking them to an emergency department.
- If your child has repeated nose bleeds, bleeding from other areas, abnormal bruising or there is a family history of a clotting disorder they may need to have blood tests. In most cases this is not needed.
- Sometimes a cream can be prescribed to help. This is called Naseptin (chlorhexidine and neomycin) and helps to reduce nose bleeds by reducing crusting and inﬂammation in the nose.
It must not be used if there is an allergy to neomycin, peanuts or soya (in these cases an alternative cream called Bactroban (mupirocin) can be used).
A pea-sized amount of cream should be squeezed into both nostrils via the nozzle and then you should close both nostrils as if you are pinching the nose to rub the cream in. This should be done 2 to 4 times per day for 2 weeks.
- Nasal cautery can sometimes help if there is a prominent blood vessel that continues to cause nose bleeds. It has been shown to be no more effective than using Naseptin cream. Cautery involves applying a chemical to a blood vessel in the nose.
This can be done in the outpatient clinic.
- Nosebleeds in children are very common but will usually settle with time.
- They tend to occur in clusters and will often recur.
- Most nosebleeds can be treated with ﬁrst aid and creams or ointments.
- It is rare for there to be any worrying underlying cause.
- Prolonged nosebleeds may need further assessment but this is not common.
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