Nose bleed is a common problem among the children. It can occur spontaneously or secondary to trauma. Most of the time the cause is not identified. It is often related to the ‘little area’ in the nose that can bleed easily.

What causes nose bleeds?

There are many causes and they include:

• Cold and allergies.
• Sinus infections.
• Trauma e.g. blowing nose too hard, picking nose, nasal injury, foreign object inside the nose.
• Deviated nasal septum.
• Growth in the nose (e.g. polyps, tumours).
• Underlying medical problems e.g. chronic kidney failure, thrombocytopenia (low platelet count) and hereditary bleeding disorder (e.g. hemophilia).
• Medications that delay blood clotting.
• Chemical irritants.

Most of the time an identifiable cause cannot be found.

What are the signs & symptoms?

• Bleeding from one or both nostrils.
• Frequent blood swallowing leading to blood-stained vomitus.
• Sensation of fluid in the back of the nose and throat.

What is the treatment for nose bleeds?

Emergency measures:

• Make the child comfortable.
• Sit him up and lean forward.
• Ask him to breathe through mouth.
• Pinch the lower soft part of the nose and hold it for 10 – 20 minutes.
• Apply an ice pack at the root of the nose to reduce the blood flow by reflex vasoconstriction (causes minimal blood flow to that area).
• Release the nose after 10 minutes and check if the bleeder has stopped.
• If still bleeding, repeat pinching the nose for another 10 minutes. If bleeding persists, seek medical help at the nearest clinic or emergency department.
• If bleeding has stopped, advise the child to sit still and do not rub, or breathe through the nose.

Definitive treatment depends on the cause, hence:

• Treat underlying medical problems.
• Advise to stop nose picking.

In uncontrolled bleeding, the ENT surgeon will treat the child accordingly. These includes nasal packing, chemical cauterization etc.

How do you prevent nose bleeds?

• Avoid nose picking and vigorous nose blowing.
• Treat underlying medical problems.

What is the complication?

In trauma cases, septal blood collection should be ruled out as this can cause saddle nose.

What is the prognosis?

Depends on the cause of the bleeding. 90% of bleeding arises from little’s area (anterior part of the nasal septum), and this has a good prognosis.