Nosebleeds are one of those childhood events that are simultaneously alarming and almost always trivial. The volume of blood from a nosebleed can look far worse than the situation actually is, and many parents panic and handle the situation incorrectly (by tipping the head back, most commonly) which prolongs rather than resolves it.
Most childhood nosebleeds come from exactly the same place: a small network of fragile blood vessels at the front of the nasal septum called Little's area. This is close to the surface, easily irritated by dry air, nose-picking (the most common cause in young children), minor trauma, or the congestion of a cold.
Healthbooq (healthbooq.com) covers common childhood health events, including first aid for injuries and minor illnesses in the early years.
Correct First Aid for a Nosebleed
Sit the child upright and lean them slightly forward, so that blood drains out of the nose and not back into the throat. Blood swallowed in quantity causes nausea and vomiting, so keeping it going forward is practically important as well as more comfortable.
Pinch the soft part of the nose firmly, just below the bony bridge. This is the part that compresses. The bony part of the nose cannot be compressed and pinching there does nothing. Hold firmly for a full 10 to 15 minutes, checking the clock rather than checking every minute or two to see if the bleeding has stopped.
During those 10 to 15 minutes, breathe through the mouth, do not blow the nose, and do not release the pinch to check whether it has stopped.
At the end of 15 minutes, release gently. If still bleeding, repeat for another 10 to 15 minutes.
Do not tilt the head back. Do not lie the child down. Do not put tissue up the nose and pull it out suddenly (it will break the clot). Do not blow the nose immediately after a nosebleed.
After it stops, it is worth keeping the child calm for 30 minutes or so to reduce the chance of the clot dislodging.
Why They Happen
The most common causes are mechanical: digital trauma (nose-picking), blowing the nose hard, a knock to the nose, or the combination of dry air and fragile mucosa during winter. Children who have frequent colds often have more nosebleeds because the mucosa is already inflamed and friable.
Allergic rhinitis, particularly in children with hay fever or house dust mite allergy, causes chronic nasal inflammation that increases nosebleed frequency.
The nasal mucosa is particularly prone to drying out in central heating during winter months, which makes the blood vessels more fragile. Humidifying the bedroom or applying a small amount of soft paraffin (Vaseline) to the inside of each nostril at bedtime can reduce frequency in children who have recurrent nosebleeds during winter.
When to Seek Help
Call 999 or go to A&E if: a nosebleed has not stopped after 30 minutes of continuous correct first aid, the blood loss appears very large, the child has a disorder that affects clotting, the child is on blood-thinning medication, or the child is faint or appears to have lost a significant volume of blood.
Seek a GP appointment if: nosebleeds are happening frequently (more than once a week regularly), the nosebleeds are heavy, or there are nosebleeds occurring alongside bruising elsewhere or other bleeding that suggests a possible clotting problem.
Recurrent nosebleeds are sometimes treated with cautery (application of a silver nitrate stick to the blood vessel under local anaesthetic), which is a quick and effective procedure usually done by an ENT (ear, nose, and throat) specialist. Referral via GP is the route.
Key Takeaways
Nosebleeds (epistaxis) are very common in children and are almost always benign, arising from the front of the nasal septum where fragile blood vessels are close to the surface. The correct first aid is to lean the child forward, pinch the soft part of the nose firmly for 10 to 15 minutes without releasing, and breathe through the mouth. Leaning back, lying down, or tilting the head back are all incorrect and allow blood to flow back into the throat. Most nosebleeds stop within 20 minutes. Recurrent or very heavy nosebleeds warrant GP assessment.
