The medical term for a nosebleed is epistaxis. Nosebleeds are extremely common in children especially those between the ages of 2 and 10 years of age. In most cases, nosebleeds are due to local trauma either from picking the nose or from drying of the nasal mucosa due to weather changes,upper respiratory tract infections, or allergies.Up to 30% of normal children have nosebleeds by the time they are five years of age. In nearly all cases nosebleeds do not represent anything dangerous. However, if nosebleeds are persistent, severe, or associated with other easy bleeding or bruising, you should contact your doctor.

What is epistaxis?

Epistaxis is the medical term for a nosebleed. Bleeding from the nose typically comes from the mucosal surface of the inside of the nose. Bleeding may be acute in onset with sudden bright red blood dripping down the face, or may present as crusted clotted blood in the nose.  occasionally, a nosebleed may cause blood to drop into the back of the throat where it is either coughed out or swallowed.

Nosebleeds can be classified as either anterior, close to the front of the nose, or posterior, close to the back of the throat. More than 90% of nosebleeds and children are anterior.

Who gets nosebleeds?

Nosebleeds are extremely common in children. Over 50% of children have at least one nosebleed before 10 years of age. Many children have multiple nosebleeds. Nosebleeds are most common in the dryer cold winter months and when the child has an upper respiratory tract infection or seasonal allergies. Some children may be sensitive to warm and dry interior environments.

Why do nosebleeds occur?

Nosebleeds are the result of damage to the small blood vessels in the mucosa of the interior of the nose. The most common source of the bleeding is a group of tiny blood vessels on the front part of the nasal septum less than 1 cm from the tip of the nose this group of blood vessels is known as Kieesselbach plexus which is located in an area of the nasal septum called Little's area.  the tissue here is thin and bleeds easily. Congestion of the blood vessels in this area caused by either an Apple respiratory tract infection or drying of the mucosa due to low environmental humidity makes bleeding a common problem.

What causes a nosebleed?

Trauma: children commonly pick their noses or rub their noses causing inflammation and damage that may lead to bleeding. Repetitive picking can lead to scab formation and granulation tissue which can increase the risk of bleeding with further irritation.

Drying of the mucosa: the anterior surface of the nose, called the nasal mucosa, is healthiest when moist. As this mucosa dries it may lead to crust formation and cracking that may disrupt small blood vessels especially when the child sneezes or forcefully blows her nose.

Upper respiratory tract infections: infections such as the common cold or influenza may predispose children to nosebleeds due to a local inflammatory effect. This can be made worse by drying of the because and recurrent nose blowing or nose picking.

Seasonal allergies: seasonal allergies, sometimes called allergic rhinitis, leads to inflammation and drying out of the interior surface of the nose. Children with these types of allergies often take medications that further dry out the nasal mucosa. Medicines such as decongestants, antihistamines, and nasal steroid sprays are very good for treating runny noses and nasal congestion but may worsen nosebleeds.

Foreign bodies: small children are notorious for placing foreign bodies in body orifices. Objects that get stuck in the nose, whether they are sharp or soft, can lead to local inflammation.

Bleeding disorders: most children with nosebleeds do not have a clotting or bleeding disorder. However, if bleeding is recurrent or severe, or is associated with easy bleeding and bruising in other parts of the body, there may be an underlying clotting disorder. Thrombocytopenia is the most common clotting disorder that leads to nosebleeds. Thrombocytopenia is the medical term for a low blood platelet count. Islets are the small pieces of tissue found in blood that help with clotting. The most common cause of the low platelet count in children is idiopathic thrombocytopenic purpura (ITP).  ITP is believed to be caused by suppression of the bone marrow, where platelets are made, due to illness or infection. The most common inherited bleeding disorder associated with nosebleeds is von Willebrand disease. This disorder runs in families it typically leads to a mildly increased risk of bleeding.

Blood vessel disorders: some children may be born with an abnormal amount of small blood vessels within the nose. An arterio-venous malformation, sometimes called simply a strawberry mark, can occur within the nose just as it can occur on the surface of the skin. Less common are telangiectasias, another abnormal collection of blood vessels often associated with other disorders.

Neoplasms: these are very rare causes of nosebleeds and children.

Drugs or medications: medicines such as aspirin or ibuprofen may increase the risk of bleeding.  Snorting of illicit drugs such as cocaine and heroin are associated with nosebleed and even nasal septum perforation.

High blood pressure: this is rarely the cause of nosebleed in children.

What are the symptoms of a nosebleed?

Bleeding.  From the nose.  But seriously... nosebleeds typically occur suddenly with bright red blood dripping from a nostril.  The amount of blood may be one drop or several teaspoons.  Some nosebleeds may present with a small amount of bright or dark blood mixed in mucus when the nose is blown.  Or there may be some dark red crust in the nostril.

How will my doctor evaluate a nosebleed?

Your doctor will ask questions to help differentiate the causes listed above. Your doctor may look within your child's nose, however, it is difficult to see the source of bleeding, especially if there are nasal secretions or blood in the nose. Your doctor will likely be most interested in determining if there is enough bleeding to cause anemia or an immediate threat to your child's safety. Your doctor will also try to determine if there are other signs of easy bleeding or bruising which may represent a bleeding or clotting disorder.

What testing is helpful for nosebleeds?

A basic blood count will tell your doctor if the bleeding is severe or current to frequently. It is really necessary to obtain a blood count and an otherwise healthy child.

How are nosebleeds treated?

Most nosebleeds will resolve on their own without any treatment.

Direct pressure: to control a nosebleed acutely, direct pressure may be applied to the nose.  Pressing or squeezing the outside of the nose for several minutes is typically enough.

Petroleum jelly: Vaseline or an antibiotic ointment can be applied inside the nose as needed.

Humidified air: placing a humidifier and a child's room may help moisturize the air especially during the winter or in dry climates.

Nasal packing: for persistent or severe nosebleeds, your doctor may choose to use some sort of nasal packing. This typically involves using a small absorptive material such as a sponge or gauze placed in the nose by your doctor.

Medications: in some cases your doctor may choose to use a medicine that constricts blood vessels in the nose. These medications should be used with caution and discussed with your doctor.

Cauterization: for persistent or severe bleeding occasionally the bleeding site can be cauterized with a chemical such as silver nitrate or even with a surgical device if necessary.

When should I worry about a nosebleed?

• Severe bleeding
• persistent bleeding
• nosebleeds associated with other sources of bleeding or easy bruising
• and ill appearing child
• vomiting or coughing up blood

What can I expect after a nosebleed?

Nosebleeds often recur. However, most nosebleeds are controlled with a minimal amount of home therapy and are harmless. If you have any concerns, of course, talk with your doctor.

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