Nosebleed (Epistaxis) (Child)
The nose has many tiny blood vessels. These can bleed when the nose is irritated by rubbing, picking, injury, foreign objects, medicine, or blowing, especially when the nasal lining is dry.
Nosebleeds are common in young children and rarely indicate a serious problem. Bleeding usually occurs in a single nostril only. A nosebleed that occurs in the front of the nose is easy to stop. Nosebleeds in the front part of the nose are more common in children and are usually not serious.
Nosebleeds in the back part of the nose, near the throat (posterior) are less common in children than nosebleeds in the front. A nosebleed that occurs deeper in the nose often comes out of both nostrils. It's harder to stop. They can be more serious and cause a lot of blood loss.
Nosebleeds in children are often caused by picking the nose. Nosebleeds are more common in children with allergies due to frequent rubbing and nose blowing. Nosebleeds also occur as a result of direct injury. They can be caused by putting objects into the nose. They may also be caused by dry air or an upper respiratory infection. Children can sometimes have nosebleeds in their sleep.
Most nosebleeds stop on their own. A newborn baby with nosebleeds may need to see an ear, nose, and throat doctor (ENT or otolaryngologist).
Home care
Follow these guidelines to control a nosebleed:
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Keep your child calm and comfort them. Make sure they are breathing through their mouth normally.
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Have your child sit or stand and lean their head forward.
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Don't let your child lie down or tilt their head back. This is to prevent them from swallowing blood. It will also keep the blood from pooling in the back of their throat. If your child seems to be swallowing blood or has a lot of blood in their mouth, have them spit the blood out. If blood is swallowed, it can cause vomiting.
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Don't have your children put their head between their knees. This can cause more bleeding. Keep a cloth or towel under their nose to absorb any blood.
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Don't put gauzes or tissues in your child's nose unless advised by your healthcare provider.
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Ask older children to gently blow their nose. Then squeeze the lower third (soft part) of the nose with your thumb and forefinger. Younger children may not understand how to blow gently.
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Continue squeezing the nose for 5 to 10 minutes without looking to see if bleeding has stopped.
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If bleeding continues, repeat the step above by squeezing the nose for 5 to 10 minutes on the lower third of the nose without looking to see if bleeding has stopped.
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You can put a cold compress or ice pack on the bony bridge of the nose.
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If the bleeding doesn't stop, contact your child's healthcare provider right away or go to the emergency room or urgent care clinic.
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Once the bleeding stops and a clot forms, tell your child not to rub or blow their nose for several days. This will allow the blood vessels to heal.
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Wash your hands carefully with soap and clean, running water after taking care of your child’s nosebleed.
Based on your child's age and the cause of their nosebleed, your child's healthcare provider will tell you how to correctly care for your child's nosebleed. Always contact the provider to discuss your child's nosebleeds.
Prevention
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Your child's healthcare provider may advise you to use a nasal saline spray, nasal gel, or nasal ointment, especially in the winter. These will moisten the inside of the nose. Follow all instructions when using these on your child.
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The provider may suggest you use a vaporizer to add humidity to the air. Clean and dry the humidifier daily to prevent bacteria and mold growth. Don't use a hot water vaporizer. It can cause burns.
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Try to keep your child from picking their nose. Nose picking is a common cause of nosebleeds.
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Treating nasal allergies may help stop cycles of itching, picking or scratching, and bleeding. Talk with the provider before giving them any over-the-counter medicine, especially for the first time.
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Don't smoke or let others smoke in the home, your car, or around your child.
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Don't give your child aspirin or other anti-inflammatory medicines. These can make nosebleeds happen more often.
Follow-up care
Follow up with your child’s healthcare provider as directed.
When to get medical advice
Call your child’s healthcare provider right away if any of these occur:
Call 911
Call 911 if any of these occur:
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Bleeding that doesn't stop after 30 minutes of direct pressure
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Trouble breathing or chest pain
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Crying or fussing that can't be soothed
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Turning pale, or becoming disoriented or severely tired (fatigued)
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Not acting normally
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Multiple nosebleeds
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Bleeding from other parts of the body, such as in the poop (stool), pee (urine), or gums, or bruising easily
Fever and children
Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:
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Rectal. For children younger than 3 years, a rectal temperature is the most accurate.
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Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.
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Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.
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Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.
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Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.
Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.
Below is when to call the healthcare provider if your child has a fever. Your child’s provider may give you different numbers. Follow their instructions.
When to call a healthcare provider about your child’s fever
For a baby under 3 months old:
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First, ask your child’s healthcare provider how you should take the temperature.
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Rectal or forehead: 100.4°F (38°C) or higher
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Armpit: 99°F (37.2°C) or higher
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A fever of ___________as advised by the provider
For a child age 3 months to 36 months (3 years):
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Rectal or forehead: 102°F (38.9°C) or higher
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Ear (only for use over age 6 months): 102°F (38.9°C) or higher
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A fever of ___________ as advised by the provider
In these cases:
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Armpit temperature of 103°F (39.4°C) or higher in a child of any age
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Temperature of 104°F (40°C) or higher in a child of any age
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A fever of ___________ as advised by the provider