Nosebleeds in Kids: What to Do & When to Get Checked
by Steve Silvestro, MD @zendocsteve
When I was a kid, my little brother would get nighttime nosebleeds all the time.
Sometimes he’d wake up in the middle of one, and sometimes he would sleep right through and not know until he saw his pillow in the morning. And on a few occasions, I’d wake up in the morning, go into the bathroom, and the sink would look like a murder scene.
Now while most nosebleeds in kids aren’t quite so theatrical, nosebleeds in general are pretty common—and frequent, messy ones do actually happen to kids more often than you might think.
Since pretty much every child is going to have a nosebleed at one point or another, it would be helpful for you to know what to do, when to get checked out, and how to prevent them so that you can calmly respond when your child comes to you with a gusher.
WHAT CAUSES NOSEBLEEDS IN KIDS?
In a way, the nose is essentially set up to bleed pretty easily. The capillaries inside the nostrils are fairly close to the surface. This means that it doesn’t take much to damage one and cause it to bleed.
Most nosebleeds in kids are caused by dry air. This is especially true of many nighttime nosebleeds. As the skin overlying the capillaries dries out, there’s less protection for those capillaries, making them more likely to break open. To understand this, picture a rubber garden hose that sits out in the sun too long—over time, it dries, cracks, and then gets leaky. Breathing dry air in and out through the nose all night long wears down at the protective layers over the capillaries, essentially allowing them to “crack” and leak.
Trauma, of course, is a frequent cause of nosebleeds in kids. Obviously, catching a baseball with your nose instead of your glove is going to lead to a bloody nose (it also gives you a nose that looks a lot like mine). And as kids from toddlers to teens go off to explore the world, a few bonks to the nose are bound to happen.
But big knocks to the nose aren’t the only type of trauma kids’ noses endure. No, the wonderful childhood hobby of picking the nose is another common cause of nosebleeds in kids at almost any age. Children with long fingernails are especially at risk.
Rounding out the most common nosebleed instigators in kids are two things that may come as a surprise: colds and allergies. Because I said that dry air is the most common cause of nosebleeds, you might not think that having a wet, runny nose from colds or allergies could do it, too. However, when the nose is stuffy, the capillaries and tissue inside the nostrils are more swollen than usual, making it easy for them to burst and result in a bloody nose.
WHAT TO DO
Luckily, most nosebleeds in kids can be managed at home without the help of a doctor.
But before we get into what to do, let’s first talk about what doesn’t help.
What DOESN’T help:
- DON’T tilt your child’s head backward. Sure, this helps to decrease how much blood is pouring out of the nose—but that’s only because it all ends up dripping down the back of the throat. Swallowing that much blood will upset the stomach, and it could be dangerous if your child inhales the blood instead of swallowing it. So don’t let someone tell you that tilting the head back is the right thing to do for a bloody nose.
What DOES help:
- Have your child sit upright. A slight forward lean is okay.
- Pinch the soft, spongy part of the nose that’s below the upper bony part. This puts pressure on the capillaries, ideally stopping the flow and allowing the blood to begin clotting.
- You can pinch the nose using a tissue or, if the bleed is particularly messy, a washcloth or paper towel.
- Hold pressure for at least 5 minutes, but expect that it may take 10-15 before the bleeding has mostly stopped.
WHEN TO SEE A DOCTOR
This is the big question, right? How do you know if your child’s nosebleed is more than just a regular old bloody nose, and instead is a reason to see the doctor?
Generally, there are two common reasons that a nosebleed should be treated by a doctor:
- If it’s actively bleeding for more than 20 minutes, or
- If there’s a chance that your child put something in his or her nose, such as a toy, a bead, etc.
In the latter instance, you should call your doctor or visit an urgent care so that the foreign body can be removed. We officially don’t recommend that parents try to remove a foreign body at home, because there is the chance that it might get pushed up even farther.
If the issue is that the nose has been bleeding for more than 20 minutes, then your child might need further treatment to stop the bleed. Your doctor or another healthcare provider can either pack the nose with gauze to encourage clot formation, or even cauterize the bleed if it is more severe.
If your child frequently gets nosebleeds that last longer than 20 minutes, then an additional workup might be necessary. The most common reason for someone to get frequent, hard-to-manage nosebleeds is that those capillaries that are close to the surface inside the nose are larger or even more superficial than in the average person. If this is the case, then an ear-nose-and-throat doctor can cauterize the troublesome capillaries.
On rare occasions, we’ll see that kids who have frequent, difficult nosebleeds also have an underlying bleeding disorder. There might be something missing or abnormal in their blood that makes it difficult to clot. Typically, these kids will also have other signs of unusual bleeding—such as frequent bleeding from the gums; very large, unusual bruises; or exceedingly heavy periods in teenage girls. If your child gets frequent nosebleeds that last over 20 minutes and also has some of these other symptoms, then your pediatrician can order a few simple blood tests to make the diagnosis.
WHAT TO EXPECT AFTER A NOSEBLEED
After having a bloody nose, a child might cough up or spit out a small amount of swallowed blood. If there was a lot that was swallowed, then your child’s next poop might be dark and sticky (though if more than one is dark and sticky, call your doctor to make sure there’s not additional bleeding elsewhere).
The most important thing I tell my patients after their kids have nosebleeds is to expect that there will be a few more nosebleeds in the next several days, especially at night. Because the capillaries in the nose are close to the surface, it’s easy for them to get damaged again while they’re still healing. So seeing another nosebleed or two in the next couple of days usually doesn’t mean that there’s anything really wrong, just that those capillaries need some extra help to heal.
HOW TO PREVENT NOSEBLEEDS
So how do you prevent future nosebleeds from arising?
Well, if your child has recently had one nosebleed, you can protect those superficial capillaries while they heal by applying a thin layer of petroleum jelly (i.e., Vaseline or Aquaphor) along the inside of the nostrils. This is most important to do at bedtime, as the air tends to be drier at night.
And whether your child recently had a nosebleed or is just prone to getting them, then keeping a clean humidifier in her room at night can add extra protection by combatting dry air.
When it comes to nosebleeds caused by trauma, well, these usually come about by surprise, so there’s not much you can do to prevent them.
Just be sure to tell your kid not to catch a baseball with the glove too close to his face…