Nose Bleeds / Epistaxis
Nose bleeds (called epistaxis in medical terminology) are a common problem in children. The nose has a very rich blood supply, and multiple blood vessels cover the inside of the nose. The inside of the nose also contains an area called Little’s area, where several blood vessels all come close together. This area is at the front of the nasal septum (the wall that divides the nose into two nostrils), and is a common area where blood vessels burst and cause nose bleeds.
Why do nose bleed happen?
Children often pick noses, which can cause irritation and bleeding. The snottiness and repeated respiratory infections also probably contribute. Children also often suffer with a condition called vestibulitis: this is infection at the front of the nose, caused by a bacterium called Staphylococcus aureus, which is introduced into the nose through touching (it's not a superbug, just a really common bug that is in the environment all around us). Any trauma to the nose can also cause bleeding. Some children have a problem with how the blood and clotting works, so that they are more prone to nose bleeds as a result (often such problems run in the family, and the child may have heavy bleeding in other parts of the body).
What should I do if my child has a nose bleed?
If your child does have a nose bleed, make sure that you pinch the soft fleshy part of the nose for a minimum of 15 minutes to try and get bleeding to stop. You should also lean your child forwards to stop the blood from passing backwards into the throat.
You should visit the Emergency Department if
-bleeding doesn't settle after 15 minutes
-you are concerned about amount of bleeding (blood stained tissues suggests smallish amounts, clots and spitting blood out usually implies more worrying amounts)
-your child feels unwell, faint or dizzy
Depending on the age of your child, other helpful measures to stop a nose bleed include applying an ice pack (or bag of peas) wrapped in a tea towel to the back of the neck, and placing a clean ice cube into the mouth. These steps cause the area around the head to cool down, shrinking the blood vessels, and hopefully reducing bleeding.
To try and prevent bleeding, applying vaseline to the nose can be helpful. This moistens and protects the nose lining, and reduces the chances of blood vessels bursting. There is no need to poke vaseline deep into the nose, just apply a bit to the front of the nose, a gentle sniff in, and then a squeeze of the nose from the outside
What else can be done to stop nose bleeds in children?
Children often grow out of nose bleeds by the age of 12 years. If your child has repeated, disruptive nose bleeds, your GP will probably prescribe a nose cream called Naseptin. This is an antibiotic cream, designed to reduce bacteria in the nose. It is the first line treatment that you are likely to be offered.
It is important that the cream is applied gently. Your child should not poke the cream deep into the nose using fingers! Instead, use the nozzle of the tube to apply, or just apply a bit to the front of the nose. Then ask your child to take a gentle sniff in, and then gently squeeze the nostrils from the outside.
The cream is based on PEANUTS, so if your child is allergic then Naseptin should not be used.
Another cream that we often use is called Bactroban (also called Mupirocin), this is also an antibiotic cream again designed to deal with bacteria in the nose.
If nose bleeds continue despite the creams, a referral to a paediatric ENT surgeon may be appropriate. They may be able to stop the bleeding by cauterising the offending vessel. This means that the use a chemical or electricity to burn the blood vessel to seal it and stop bleeding. This can be done in clinic depending on what needs to be done and whether your child is able to tolerate it, but sometimes need to be done in theatre with the child asleep under general anaesthetic.
Nilesh Vakharia MBBS BSc
Core Surgery Doctor