• Dr Claudine DeMunter

Nosebleeds (Epistaxis)

What is a nosebleed?


A nosebleed is bleeding from the delicate nasal membranes inside the nose, caused by broken blood vessels. The medical term for this is epistaxis. Most nosebleeds occur in the front part of the nose close to the nostrils. Epistaxis occurs most often in children between the age of 2 and 10 and in older people and is unusually a serious problem.


Nose bleeds occur more often in dry air that irritates and dehydrates the nasal membranes. They also occur during the winter because of the dry heated air in homes. Other causes of epistaxis are:


  • the picking of the nose (second most common cause)

  • blowing the nose too hard

  • trauma to the nose

  • colds and allergies causing nasal congestion

  • object in the nose

  • Some bacterial infections can cause sore, red, crusted skin in the nose and in the front of the nostrils.


In rare cases, frequent nosebleeds are caused by blood clotting disorders or abnormal blood vessels. In many cases, no specific cause for a nosebleed is found. Many children outgrow nosebleeds during their teen years.


If the bleeding comes from the front of the nose, it generally involves only one nostril. Bleeding higher up in the nasal cavity may come out from both nostrils. It is often painless or there may be discomfort if caused by an injury or an area of sore tissue inside the nose.


How is a nosebleed treated in a child?


  • Calm and comfort your child and sit your child up and lean forward.

  • Do not lie your child down to avoid the swallowing of blood.

  • Pinch the nostrils closed for 5 to 10 minutes and do not stop pinching to check

  • Once the bleeding stops, make sure the nose is not rubbed, picked, or blown for a few days till the blood vessels heal.

  • If the bleeding doesn’t stop after 20 minutes, consult a doctor. In some cases, an ENT doctor may apply heat to close a blood vessel. This is called cauterisation and is a quick procedure.

  • Do not put tissues or gauze in the nose as this may irritate further


If the bleeding does not stop, repeat the above steps again.


How can I help prevent a nosebleed in my child?


  • Run a cool mist humidifier in the room at night

  • Avoid nose picking or blowing too hard

  • Use saltwater (saline) nose drops or spray to keep the inside moist

  • Rub a thin layer of petroleum jelly on the mucous membrane inside the nose several times a day to help protect the mucus membranes

  • Identify allergies that may lead to nosebleeds


When should I call my child’s doctor?


  • Nosebleed does not stop after 15 minutes

  • There is an injury to the head or face

  • There is a large amount of blood

  • Your child feels faint, weak, ill, or has trouble breathing

  • There is bleeding elsewhere: stool, urine, or gums, or bruises easily everywhere

  • An object is stuck in the nose

  • If the nose bleed begins after the child starts taking a new medication


A nosebleed requires urgent medical attention if:


  • It continues after 20 minutes of applying pressure

  • It occurs following a head or face traumatic injury

  • It is associated with intense headache and/or a fever

  • The child’s nose appears broken

  • The child shows signs of having lost too much blood: pale, little energy, dizzy

  • The child begins coughing up or vomiting blood - However this is commonly associated with nose bleeds when the child has been encouraged to swallow, not spit out the blood and although alarming is not unexpected

  • The child has a bleeding disorder or is taking blood thinners