Nosebleeds: A-to-Z Guide from Diagnosis to Treatment to Prevention

Little boy with a nose bleed in a red and white shirt. Nosebleeds are common in children.Introduction to nosebleeds:

We are built to be concerned at the sight of blood – especially the blood of our children. When we see a nosebleed, our immediate concern is about blood loss, but fears of anemia, leukemia, or hemophilia may dance in the shadows.

What are they?

Blood can flow from the nose for many reasons, most of which are not serious. Moreover, the amount of blood lost from most nosebleeds is quite minor.

The blood vessels of the nose are fragile and close to the surface. The thin mucus membrane makes these vessels very susceptible to minor trauma and to cracking and drying.

A finger (or other foreign body) in the nose is a very common cause of bleeding, even if the blood flow does not start right away. A cold or nasal allergy produces swelling and irritation in the nose that make the nose more likely to bleed spontaneously. Sneezing or blowing the nose can also trigger a bleed. Dry air or irritating fumes can cause a bleed, alone or in combination with other factors. In young children, irritation from GE reflux can trigger a bleed.

Occasionally the bleeding may be caused by a congenital problem, such as a hemangioma. Disorders of blood clotting, for instance, from low platelets, from hemophilia, or from medications are an uncommon cause.

Chronic illnesses can also lead to nosebleeds, but generally, people are well aware of this illness long before the nosebleed.

Who gets them?

Almost all children will have at least one nosebleed; most will have several. During the preschool years, some children will have several benign nosebleeds a week. They get less common after puberty.

Nosebleeds are more common in the winter months when the dry air can cause the lining of the nose to dry out. A dry climate can have the same effect any time of the year.

Nosebleeds are also more common among those with nasal allergies or colds.

What are the symptoms?

Most nosebleeds start silently, without warning. Red blood begins to flow freely from one, or sometimes both, nostrils.

A nosebleed is usually painless. If blood flows down from the back of the nose and is swallowed, it can trigger vomiting.

Are they contagious?

No.

How long do they last?

With proper treatment, a nosebleed usually lasts less than ten minutes.

How are they diagnosed?

A nosebleed is diagnosed by observing the blood. Frequent or severe nosebleeds may be evaluated to look for the underlying cause.

How are they treated?

There are many home remedies suggested for nosebleeds, from ice packs to various positions for the head. Keeping the child quiet, and tilting the head forward, are good ideas, but the most important step, as with most bleeding, is to apply direct pressure. For nosebleeds, this means gently pinching the soft part of your child’s nose against the center, using a thumb and forefinger.

This pressure should be held in place for 5-10 minutes by the clock, without peeking to see if the bleeding has stopped until the time is up. If the bleeding has not yet stopped entirely, you may repeat this one time.

In most cases, the bleeding will have stopped. If not, contact your physician or have your child seen right away.

The doctor might use nose drops to constrict the blood vessels or a special dressing to stop the bleeding.

How can they be prevented?

Saline nose drops or a humidifier for the home can keep the lining of the nose soft and moist.

Some find added relief by applying Vaseline, using a cotton swab, to the inner surfaces of the nostrils.

Decreasing nose-picking, sneezing, and nasal congestion can also prevent some nosebleeds.
If a particular vessel causes troublesome bleeding, a physician might cauterize it to prevent further bleeding.

Related concepts:

Epistaxis.

Dr. Alan Greene

As a father of four himself, Dr. Greene has devoted himself to freely giving real answers to parents' real questions -- from questions about those all too common childhood conditions to those that address the most recent and rare pediatric illnesses. His answers combine cutting edge science, practical wisdom, warm empathy, and a deep respect for parents, children, and the environment. He is also an electrifying public speaker, and has personally touched many during his talks in North America, Europe, Asia, and the Middle East.

Dr. Greene is a graduate of Princeton University and the University of California at San Francisco. Upon completion of his pediatric residency program at Children's Hospital Medical Center of Northern California he served as Chief Resident. He entered primary care pediatrics in January 1993.

Dr. Greene is the Past President of The Organic Center and on the Board of Directors of Healthy Child Healthy World. He is a founding partner of the Collaborative on Health and the Environment. He also consults for the Environmental Working Group.

In 1995, he launched DrGreene.com, cited by the AMA as “the pioneer physician Web site” on the Internet. His award-winning site has received over 80 million Unique Users from parents, concerned family members, students, and healthcare professionals. In addition to being the founder of DrGreene.com, he is the Medical Director for HealthTap.

In 2010 Dr. Greene founded the WhiteOut Movement to change how babies in the United States are fed. In 2012 he founded TICC TOCC - Transitioning Immediate Cord Clamping To Optimal Cord Clamping. He is also the founder of KidGlyphs, a free iPhone app that provides a tool for young children to express themselves beyond their verbal skills while teaching them important language skills.

Dr. Greene is the Founding President of the Society for Participatory Medicine and has served as both President and Board Chair of Hi-Ethics (Health Internet Ethics. He is on the Board of Directors for Healthy Child Healthy World, The Lunchbox Project, and The Society for Participatory Medicine. He has also served as an advisor to URAC for both their inaugural and their updated health web site accreditation program. He is a founding member of the e-Patient Scholars Working Group, and a founding board member of the Center for Information Therapy.

Dr. Greene is a regular columnist for Parenting Magazine. He is also the Pediatric Expert for The People’s Pharmacy (as heard on NPR) and Healing Quest (seen on PBS stations). He was the original Pediatric Expert for both Yahoo! and iVillage.

Dr. Greene is the author of Feeding Baby Green (Wiley, 2009), Raising Baby Green (Wiley, 2007), From First Kicks to First Steps (McGraw-Hill, 2004), The Parent's Complete Guide to Ear Infections (People's Medical Society, 1997), and a co-author of The A.D.A.M. Illustrated Family Health Guide (A.D.A.M., Inc., 2004). He is the medical expert for three additional books, The Parent's Soup A-to-Z Guide to Your New Baby, (Contemporary Books, 1998) The Parent's Soup A-to-Z Guide to Your Toddler, (Contemporary Books, 1999), and The Mother of All Baby Books, (Hungry Minds, Inc., 2002).

Dr. Greene is a frequent keynote speaker at important events such as Health 2.0 2011 held in San Diego, CA, IFOAM 2008 (International Federation of Organic Agriculture Movements), held in Modena Italy, the first European Internet health conference, held in Maastricht, the first International eHealth Association Conference, held in Jeddah, and the largest e-Healthcare World Conference, held in Las Vegas, and the first Green Power Baby Shower, held in Hollywood. Dr. Greene also appears frequently on TV, radio, websites, and in newspapers and magazines around the world, including such venues as the TODAY Show, Good Morning America, Fox and Friends, The Dr. Oz Show, CNN, ABC, CBS, and NBC network news, NPR, The New York Times, The Wall Street Journal, USA Today, Time Magazine, Parade, Parenting, Child, Baby Talk, Working Mother, Better Home's & Gardens, and the Reader's Digest.

Dr. Greene loves to think about challenging ideas, he enjoys being where nothing manmade can be seen, and he wears green socks.

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