Help - my child's nose keeps bleeding!
We all know that children occasionally have nosebleeds. In most cases they are no more than a minor inconvenience, but nevertheless it can be worrying as a parent to see our child bleeding! What can we do to manage nosebleeds when they happen, and how can they be reduced?
First aid for nosebleeds
Nosebleeds (also known as epistaxis) are very common in children. It's important to remember that it is very rare for children's nosebleeds to represent a significant health problem. Most of the time, good first aid technique and some simple treatments are enough to make them more manageable.
If your child has a nosebleed, don't panic. Keep them calm and sit them down with their head slightly bent forward. Squeeze the widest, softest part of the nose (right at the bottom), completely closing the nose, and don't let go for 10-15 minutes. Some people have been taught to squeeze the upper bony bridge of the nose, but this is ineffective.
It is important to stay calm and not to let go of the nose prematurely, to give the blood a chance to clot. Placing an ice pack on the forehead can also help if your child will allow it. If a nosebleed won't stop after 30 minutes, you should take your child to the nearest Emergency Department.
What can be done about frequent nosebleeds?
It is unusual for a single nosebleed in a child to be severe enough to attend hospital as an emergency. If your child is having nosebleeds more frequently (e.g. at least weekly), it may be worthwhile seeking help. Your doctor will ensure you are performing first aid correctly, and may occasionally suggest some blood tests (although these are frequently normal).
The first and simplest treatment for frequent nosebleeds is a course of nasal ointment (e.g. Naseptin). This moisturises the nose and reduces colonisation by certain bacteria, allowing the delicate lining of the nose to heal. Your doctor should demonstrate how to administer the ointment for best effect. If the nose is very dry (for example in cold weather), it can help to use Vaseline or a similar ointment on a more regular basis.
If good first aid and nasal ointments have been tried, but your child is still having frequent nosebleeds, it can help to see a specialist. It can be helpful to check your child's haemoglobin levels and clotting with a blood test. An ENT specialist can examine the nose, and in many cases, can cauterise a small area inside the nose where most nosebleeds originate.
Cauterising the nose is quick (less than a minute), simple, and tolerable even for quite young children. Local anaesthetic spray or solution can be used inside the nose so that the only sensation during the procedure is a mild tingly feeling. It does not work in all patients, and can sometimes only work temporarily. If your child is not able to tolerate cauterisation, or if cauterisation fails, the next step is to consider examining the nose under a general anaesthetic (asleep). Small blood vessels inside the nose can be precisely targeted using small electric instruments called bipolar forceps.