Spontaneous Epistaxis (Nosebleeds) in Children

What causes nosebleeds?

A nose starts to bleed when one of the small veins in its lining bursts. This is usually caused by something completely harmless, such as the child picking their nose, blowing it too hard or having their nose knocked while playing.

Another reason could be that the child has pushed something inside their nose.

spontaneous nosebleeds can startle the observer because of the apparent volume of the bleeding and the absence of evident cause. Moreover, they are sloppy - getting all over clothing and bed linens. Awareness of the mechanism, causes and treatment of epistaxis in children can lessen anxiety about the process and, hopefully, prevent some of the sloppiness!

Just inside the nostril is a collection of capillaries (called Hasselbach's plexus) on the middle wall of the nose. This is the most common site of spontaneous nosebleeds in children. Simple inspection of this area after a nosebleed can often identify the offending vessels - a pleasant job most often left to the pediatrician. These blood vessels, which are simply tubes constructed of cells that are adherent to one another, become dilated when inflamed. This dilatation creates gaps between the cells, which can no longer withstand increasing pressure of the blood that fills the vessels. This pressure is less when a person is quietly standing so that gravity pulls blood away from the face.

However, as a result of increases in local pressure when reclining or bending over, when sneezing or coughing, or when experiencing a minor injury not normally forceful enough to cause a nosebleed, the dam bursts and the blood gushes out. Actually, although the volume of blood often seems to be greater than that of the Mediterranean Sea, it is usually only a couple of teaspoon's worth. Signs that the bleeding is excessive include light-headedness, pallor, rapid pulse, rapid respirations or low blood pressure. Should any of these rare occurrences supervene, you should either call the Rescue Squad or transport your child to a medical facility as soon as you can.

Among the common reasons for the lining of the nose to be inflamed are colds, allergies (even in the absence of other allergy symptoms) and overuse of decongestant nose drops. Other topical or oral medications may also trigger nosebleeds. Less common conditions that can cause recurrences of nosebleeds or bleeding from other sites usually involve abnormal platelet function or number, or inability to clot. An examination by your pediatrician, sometimes supplemented by simple laboratory tests, can usually determine the cause.
How should nosebleeds be treated?

A nosebleed can be a very traumatic event for the child. They will often be scared and think something is seriously wrong with them because there is so much blood. So it is important that the parent stays calm. They should cuddle the child and say something reassuring, like, 'It's OK, let's sit down, then you'll be fine. I'm here and I'll make sure you're OK.'

When the child is sitting down, hold their nostrils with your fingers, a handkerchief or a facecloth.
Pinch the lower, soft part of the nose between the thumb and forefinger.
The grip should be firm and the pressure on the nose steady.
Hold the child's nose for 10 minutes. Look at a watch so you are sure 10 minutes have passed before letting go.
If the child is old enough, teach them how and where to hold their own nose.
If in doubt, have the doctor or health visitor show you how to hold the nose.
It may be a good idea to read a story or watch television while waiting, to divert the child's attention.
After the nosebleed has stopped, the child should not play any rough games for a couple of hours to prevent the nosebleed starting again.
Tell the child not to pick, rub or blow their nose for a couple of days.
If the bleeding continues, try the same procedure once more.
If the bleeding doesn't stop, call the doctor.


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