Definition:

* Bleeding from 1 or both nostrils

* No known injury

Causes:

• Nosebleeds are common because of the rich blood supply of the nose. Common causes include

– Dryness of the nasal lining (eg, from forced air furnace in winter)

– Antihistamines (Reason: they also dry the nose)

– Vigorous nose blowing

– Ibuprofen (eg, Advil) and aspirin (Reason: increase bleeding tendency)

– Suctioning the nose can sometimes cause bleeding

– Picking or rubbing the nose

– Predisposing factors that make the nasal lining more fragile (eg, nasal allergies, colds, sinus infections)

Call 911 Now (Your Child May Need an Ambulance) If:

Fainted, or too weak to stand

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK) If:

* You think your child has a serious injury

* Bleeding does not stop after 10 minutes of direct pressure applied correctly and tried twice

* New skin bruises or bleeding gums not caused by an injury are also present

* Large amount of blood has been lost

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

You think your child needs to be seen

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Child is younger than 1 year

* New-onset nosebleeds are occurring frequently

* Hard-to-stop nosebleeds are a recurrent chronic problem

* Easy bleeding present in other family members

Parent Care at Home If:

Mild nosebleed and you don’t think your child needs to be seen

Home Care Advice for Nosebleeds:

1. Reassurance:

* Nosebleeds are common

* You should be able to stop the bleeding if you use the correct technique

2. Apply Pressure:

* Gently squeeze the soft parts of the lower nose against the centre wall for 10 minutes. This should apply continuous pressure to the bleeding point.

* Use the thumb and index finger in a pinching manner

* If the bleeding continues, move your point of pressure

* Have your child sit up and breathe through the mouth during this procedure

* If it re-bleeds, use the same technique again.

3. Insert Gauze:

* If pressure alone fails, insert a gauze wet with a few decongestant nose drops (eg, nonprescription Afrin) (Reason: the gauze helps to apply pressure and nose drops shrink the blood vessels).

* If not available or your child is younger than 1 year, use petroleum jelly applied to gauze.

* Repeat the process of gently squeezing the lower soft parts of the nose for 10 minutes.

4. Prevent Recurrent Nosebleeds:

* If the air in your home is dry, use a humidifier to keep the nose from drying out

* Apply petroleum jelly to the centre wall of the nose twice a day to promote healing

* For nose blowing, blow gently

* For nose suctioning, don’t put the suction tip very far inside. Also, move it gently.

* Avoid aspirin and ibuprofen (eg, Advil) (Reason: increase bleeding tendency)

5. Expected Course: More than 99% of nosebleeds will stop following 10 minutes of direct pressure if you press on the right spot. After swallowing blood from a nosebleed, your child may vomit a little blood or pass a dark stool tomorrow.

6. Call Your Doctor If:

* Unable to stop bleeding with 20 minutes of direct pressure

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt