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Seeing Red

Nosebleeds are common in childhood, but sometimes there's more than meets the eye

May 01, 2011
Most children will encounter one eventually – whether it's from a blow to the face on the soccer field, a fall from a bike, or seemingly no reason at all. Nosebleeds cause almost as much trauma for parents, who have to act quickly to stop both the tears and the blood flow.

What's the best way to manage a nosebleed? And how do you know if it's routine – or a red flag?

Why nosebleeds happen

In addition to simple childhood accidents, nosebleeds can be triggered by a variety of things. The most common causes of nosebleeds in children are nose picking or irritation from colds or allergies. Dryness also can be a culprit. Using a humidifier, saline sprays or a bacterial ointment on the nostrils at night may help combat the problem.

Children are especially prone to nosebleeds because the blood vessels in their nose are close to the skin's surface. As they reach puberty, their faces grow and their blood vessels burrow deeper beneath the surface.

What to do

Most nosebleeds are brief and easy to control. Follow these steps:

• Have your child sit calmly with his or her head forward. Do not put the head back, as this allows blood to go down the throat and can cause problems with breathing or lead to nausea and vomiting.

• Pinch the nose tightly for at least five minutes, just below where the bony portion of the nose ends. Don't check to see if the bleeding has stopped during this time.

• Repeat the process if necessary for a longer period if the bleeding has not stopped after five minutes. Do not put tissue or cotton in the nose, as this may irritate the lining of the nose and increase the bleeding.

• Go to the emergency room if the bleeding continues for more than 15 minutes and shows no signs of slowing down.

Once the bleeding has stopped, do not allow your child to blow his or her nose to try to remove the clot, because this may cause the bleeding to resume.

When to see a doctor

If your child has nosebleeds often or seems to bruise easily, it's natural to worry. But in most cases, children with frequent nosebleeds (defined as occurring once a month) have no underlying medical issue. See a doctor for further evaluation when:

• Your child has frequent nosebleeds that require a visit to the ER.

• Blood loss has resulted in iron deficiency or need for a transfusion.

• Your child develops tiny red spots on the skin.

• There is a family history of bleeding disorders. (Bleeding disorders in children are uncommon, but it is better to be safe than sorry.)

For more information, please visit rileyhospital.org.

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Dr. Kenneth Lazarus is a pediatric hematologist/oncologist at Riley Hospital for Children at Indiana University Health North Hospital

Tags: In This Issue, Health, Kids, Parenting

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