What Causes Nosebleeds in Children?

Written by Jennifer Gruen MD

The purpose of the nose is to warm and humidify the air that we breathe in. The nose is lined with many blood vessels that lie close to the surface where they can be injured and bleed.

Once a vessel starts to bleed, the bleeding tends to recur since the clot or scab is easily dislodged. Nosebleeds, called epistaxis, can be messy and even scary, but often look worse than they are.

Many can be treated at home, but some do require medical care. Most nosebleeds occur in the lower, inner, anterior portion of the nose (the nasal septum) where multiple blood vessels meet to form the Kiesselbach’s plexus

Common causes of nosebleeds in children include:

• Dry, heated, indoor air, which dries out the nasal membranes and causes them to
• become cracked or crusted and bleed when rubbed or picked or when blowing the nose (more common in winter months)
• Dry, hot, low-humidity climates, which can dry out the mucus membranes
• Colds (upper respiratory infections) and sinusitis, especially episodes that cause repeated sneezing, coughing, and nose blowing
• Vigorous nose blowing or nose picking
• The insertion of a foreign object into the nose (we have seen legos, crayons, peas…)
• Injury to the nose and/or face
• Allergic and non-allergic rhinitis (inflammation of the nasal lining)
• Tumors or inherited bleeding disorders (rare)

How are nosebleeds stopped?

Follow these steps to treat a nosebleed:

• Have your child sit with her head slightly forward. This will keep the blood from running down the throat, which can cause nausea and vomiting.
• Do NOT have your child lay flat or put her head between her legs.
• Have your child breath through her mouth.
• Use a tissue or damp washcloth to catch the blood.
• Use your thumb and index finger to pinch together the soft part of the nose. Make sure to pinch the soft part of the nose against the hard bony ridge that forms the bridge of the nose. Squeezing at or above the bony part of the nose will not put pressure where it can help stop bleeding.
• Keep pinching the nose continuously for at least 5 minutes (timed by clock) before checking if the bleeding has stopped. If the nose is still bleeding, continue squeezing for another 10 minutes.
• You can spray an over-the-counter decongestant spray, such as oxymetazoline (Afrin®, Dristan®, Neo-Synephrine®, Vicks Sinex®, others) into the bleeding side of the nose and then hold apply pressure to the nose as described above.

WARNING: These topical decongestant sprays should not be used for more than 2-3 days.)

• For several days after a nosebleed (or on a regular basis if your child tends to have nosebleeds frequently) apply Vaseline with a cotton swab to the inner, lower third of each nostril to help protect the mucosa from drying out and rebleeding.

When should your child be seen for nosebleeds?

• Bleeding persists after more than 15 to 20 minutes of applying direct pressure.
• Repeated episodes of bleeding.
• The bleeding is rapid or the blood loss is large (exceeds a coffee cupful).
• The bleeding was caused by an injury, such as a fall or other blow to the nose or face, and is not easily stopped.
• The blood goes down the back of your child’s throat rather than out front through the nose even though she is sitting down with body and head leaning slightly forward.
• (This may indicate the rarer, but more serious, “posterior nosebleed,” which almost always requires a physician’s care. This condition occurs more frequently in older people).
• Nosebleeds accompanied by unusual bruising all over the body, or other types of bleeding (heavy periods, frequent bleeding with toothbrushing, etc.)

How to prevent nosebleeds:

• Use a saline nasal spray or saline nose drops two to three times a day in each nostril. These products can be purchased over-the-counter or made at home. (To make the saline solution at home: mix 1 teaspoon of salt into 1 quart of tap water. Boil water for 20 minutes, cool until lukewarm.)
• Add a humidifier to your furnace or run a humidifier in your child’s bedroom at night.
• Place water-soluble nasal gels or ointments in your nostrils with a cotton swab.
• Bacitracin®, Vaseline®, or Ayr Gel® are examples of over-the-counter ointments that you can use. These gels and ointments can be purchased in most pharmacies.
• Teach your child to sneeze through an open mouth (into the crook of the arm).
• Teach your child not to put anything into their nose, including fingers and cotton applicators.
• If nosebleeds seem to worsen with allergen exposure (pollens, molds, animal dander) your child may need a prescription nasal spray- please call for an appointment.

Dr. Gruen opened her practice, Village Pediatrics, in 2009, but prefers spending time creating fantastic kids birthday parties