Nosebleed in children is a very common terrifying experience for many parents. Studies have shown that up to 9% of children can have recurrent nosebleeds or epistaxis. The most common cause is trauma, dry air or inflammation of the anterior septum. In another words, nose picking or rubbing of the nose results in a broken blood vessels, small wound / traumatic area over the front part of the nose close to the nostril. The anterior most part of the septum known as Little's Area has many tiny blood vessels.
Which Children have a higher chance of Nasal Bleed?
Although a nosebleed looks horrifying, the causes are often very simple. The risk is higher for children with:
Habit of nose picking / rubbing
Nasal Allergy
Living in dry climate
Having cold / nasal congestion
Common presentations of a Nasal Bleed
Most commonly children present with painless bleeding from a single nostril where child complaints of blood drops from the front of a single nose. Bleeding from both nostrils simultaneously is suggestive of bleeding point or source deeper into the nose.
If there is history of recurrent epistaxis, it calls for a detailed evaluation of the nose with a diagnostic nasal endoscopy. A detailed evaluation is the key to ensure that all local causes are checked and a plan for further evaluation can be made if no local cause is identified.
Immediate MUST DO during a Nasal Bleed in Children
Caregiver should immediately give confidence and reassure the child that he/she is going to be just fine.
Advice child to lean forward, to ensure that blood does not trickle into the throat. In case of any blood trickling into the throat should be ideally spat out. Swallowed blood can be an irritant to the stomach resulting in vomiting.
Pinch the soft part of the nose between the thumb and index finger tightly for ten minutes while breathing through the mouth for 10 minutes. Always remember that pinching the wrong part of the nose like the bony area is not going to help in applying pressure over the bleeding spot.
If the bleeding is not controlled despite of pinching the soft part of the nose for up to 20 minutes, its recommended to take the child to a hospital.
Treatment for Epistaxis
In most cases, no active intervention is required for cases with history of nose picking. Antiseptic creams are prescribed to improve the process of healing and to reduce cresting.
Multiple reminders by parents to avoid nose picking is also essential
Another category of patients or children may require a chemical cauterization of the bleeding to cease the bleeding and to promote the process of healing
Rarely further management like Sphenopalatine Artery Ligation is required for severe recurrent cases of epistaxis.
Reference
1. D'Oto AD, Cox S, Svider P, Rangarajan S, Sheyn A. Safety and efficacy of sphenopalatine artery ligation in recalcitrant pediatric epistaxis.Int J Pediatr Otorhinolaryngol. 2019;123:128-131. doi:10.1016/j.ijporl.2019.05.005
2. McGarry GW. Recurrent epistaxis in children.BMJ Clin Evid. 2013;2013:0311. Published 2013 Oct 30.
Comments