Nosebleed
A nosebleed happens when one of the blood vessels in the lining of the nose bursts. Nosebleeds may be caused by infection, injury, allergic reaction, nose picking or an object being pushed into the nostril. Another name for nosebleed is epistaxis.
Bleeding from the nose is common in children and is usually not serious. Seek medical attention if nosebleeds are severe, frequent or prolonged.
Blood vessels in the nose are fragile
The small blood vessels in the septum (the firm tissue between the nostrils, which divides the nose into two halves) are fragile and can burst fairly easily, causing a nose bleed.
In children, the nose tends to bleed from only one side (unilateral).
Children usually grow out of the condition. If the bleeding is very heavy, prolonged or does not stop with first aid measures, take your child to a doctor or a hospital emergency department.
Symptoms of nosebleeds
The signs and symptoms of a nosebleed include:
bleeding from either or both nostrils
a sensation of flowing liquid at the back of the throat
the urge to swallow frequently.
Causes of nosebleeds
A nosebleed can be caused by a range of factors, including:
fragile blood vessels that bleed easily, perhaps in warm dry air or after exercise
an infection of the nose lining, sinuses or adenoids
an allergy that causes hay fever or coughing
bumps or falls
an object that has been pushed up the nostril
nose picking
occasionally, a bleeding or clotting problem.
First aid management for nosebleeds
To manage a nosebleed include:
Reassure the person, especially children, as crying increases blood flow.
Sit the person up straight and drop their head slightly forward.
Apply finger and thumb pressure on the soft part of nostrils below the bridge of the nose for at least 10 minutes.
Encourage the person to breathe through their mouth while their nostrils are pinched.
Loosen tight clothing around the neck.
Place a cold cloth or cold pack over the person’s forehead and one around the neck, especially around the sides of the neck.
After 10 minutes, release the pressure on the nostrils and check to see if the bleeding has stopped.
If bleeding persists, seek medical aid.
Tell the person not to sniff or blow their nose for at least 15 minutes and not to pick their nose for the rest of the day. (Having a nose full of clotted blood is unpleasant and children, in particular, may find it difficult to avoid sniffing or nose blowing for a few hours. Fifteen minutes will at least give some time for the clot to stabilize.)
You should go to the doctor or a hospital emergency department if the bleeding does not stop after simple first aid management. It is important to find and treat the cause of ongoing bleeding.
Frequent nosebleeds
If your child keeps having nosebleeds, see your doctor as the cause needs to be understood and treatment commenced. For example, if the cause is an ongoing infection, your doctor may prescribe an antibiotic ointment or medicine. Very occasionally, a child loses so much blood that this causes other health problems, such as anemia.
When to see a doctor
If after trying first aid the bleeding continues, take your child to the GP or your nearest hospital emergency department. A doctor will look up into your child’s nose with a light to see if they can find the bleeding blood vessel.
The doctor may then:
- Apply a cream or ointment that contains a special medicine to slow the blood flow to the inside of your child’s nose.
- Use cautery, which is a special chemical that freezes or burns the blood vessel to stop the bleeding (a process referred to as cauterization).
- Pack your child’s nose with a dressing. The doctor may also prescribe antibiotics to prevent bacterial infection while the packing is in the nose. Occasionally, children who need nasal packing may be admitted to the hospital overnight.
If nasal packing is not needed, your doctor may prescribe an antibiotic ointment to be applied to the inside of your child’s nose up to four times a day for a week or so to clear any mild infection that may be present.
For severe nosebleeds, your child may need to have a blood test to check how much blood they have lost.
Take your child to the GP if they:
- have nosebleeds frequently over a period of several weeks
- have nosebleeds and bruised skin anywhere on the body, pale skin or a family history of bleeding disorders.
Your child may be referred to an ENT (ear, nose, and throat) specialist.
Care at home
After a nosebleed:
- Rest your child for the next couple of hours if the nosebleed was not severe (you were able to stop it yourself using first aid). Rest for 12–24 hours if it was a severe nosebleed that needed medical assistance. Quiet activities such as drawing or reading a book are recommended.
- Avoid giving your child hot drinks or food, or hot baths or showers for at least 24 hours.
- Tell your child not pick or blow their nose for 24 hours (and for a week if they have had their nose cauterized).
- If your child’s nose has been packed, the gauze will need to remain in place for 24–48 hours. You will need to take your child to the GP for a check-up and to have the gauze removed. Do not try to remove the packing yourself. If it falls out on its own and the bleeding doesn’t return, there is no need to go back to the emergency department or GP.
To help prevent nosebleeds in the future:
- If your child’s nose is dry and cracked, apply a petroleum-based gel or ointment (e.g. Vaseline) to the nostrils, generally twice each day for a week. This can be done by using a cotton tip or finger and gently rubbing it on the inside of the nose. Do not use this method in children under four years of age as they are unlikely to cooperate or sit still, and their nose may be injured.
- If your child is suffering from constipation, increase their fluid intake and the amount of fiber in their diet, or ask your doctor or pharmacist for a stool softener to prevent them from straining. See our fact sheet Constipation.