Epistaxis or Nosebleed in children

Epistaxis or Nosebleed Overview

Epistaxis or Nosebleeding from the nose, is a common complaint. It is rarely life threatening but may cause significant concern, especially among parents of small children. Most Epistaxis or nosebleeds are benign, self-limiting, and spontaneous, but some can be recurrent. Many uncommon causes are also noted.

Epistaxis or nosebleed  can be divided into 2 categories, anterior bleeds and posterior bleeds, on the basis of the site where the bleeding originates

The true prevalence of epistaxis is not known, because most episodes are self-limited and thus are not reported. When medical attention is needed, it is usually because of either the recurrent or severe nature of the problem.

Epistaxis or Nosebleed in children

Having a Epistaxis or nosebleed is common in children. Epistaxis or Nosebleeds are usually mild and easily treated. Sometimes bleeding can be more severe. This is usually in older people, or in people with other medical problems such as blood disorders. Get medical help quickly if the bleeding is severe, or if it does not stop within 20-30 minutes.

Epistaxis or Nosebleeds in children can be an anxiety-provoking event, both for the parent and the child. However, most Epistaxis or nosebleeds in children are self-limiting and benign, and can typically be managed at home. As in adults, most Epistaxis or nosebleeds in children originate anteriorly.

Epistaxis or Nosebleeds in children usually occur between 2 to 10 years of age. Epistaxis or Nosebleeds in infants, however, are unusual and require further evaluation by a health care practitioner. Though most Epistaxis or nosebleeds in children are spontaneous and occur infrequently, some children may experience more frequent, recurrent nosebleeds.

The most common cause of Epistaxis or nosebleeds in children is from minor trauma, typically from nose picking. Direct trauma to the nose, upper respiratory infections, nasal foreign bodies, allergic rhinitis, exposure to warm, dry air and nasal medications (for example, corticosteroids) are also other commonly encountered conditions leading to Epistaxis or nosebleeds. Less common causes of Epistaxis or nosebleeds in children include vascular malformations, leukemia, nasal tumors, and various blood clotting abnormalities. An accidental ingestion of blood-thinning medication (for example, warfarin [Coumadin]) is also a rare cause of Epistaxis or nosebleeds in children.

The treatment for Epistaxis or nosebleeds in children is similar to that of adults, which will be covered in a subsequent section. The prognosis in children is generally excellent, with Epistaxis or nosebleeds caused by serious underlying medical conditions carrying a variable prognosis.

Epistaxis or Nosebleed causes

Most nosebleeds do not have an easily identifiable cause. However, trauma to the nose is a very common cause of nosebleeds. Nosebleeds can be caused by trauma to the outside of the nose from a blow to the face, or trauma to the inside of the nose from nose picking. Other conditions that predispose a person to nosebleeds include:

♦  exposure to warm, dry air for prolonged periods of time,
♦  nasal and sinus infections,
♦  allergic rhinitis,
♦  nasal foreign body (object stuck in the nose),
♦  vigorous nose blowing,
♦  nasal surgery,
♦  deviated or perforated nasal septum, and
♦  cocaine use.

Less commonly, an underlying disease process or taking certain medications may cause a nosebleed or make it more difficult to control.

♦  Inability of the blood to clot is most often due to blood-thinning medications such as warfarin (Coumadin), clopidogrel bisulfate (Plavix), nonsteroidal anti-inflammatory drugs (NSAIDs), or aspirin.
♦  Topical nasal medications, such as corticosteroids and antihistamines, may sometimes lead to nosebleeds.
♦  Liver disease, chronic alcohol abuse, kidney disease, platelet disorders, and inherited blood clotting disorders can also interfere with blood clotting and predispose to nosebleeds.
♦  Vascular malformations in the nose and nasal tumors are rare causes of nosebleeds.
♦  High blood pressure may contribute to bleeding, but is rarely the sole reason for a nosebleed. It is often the anxiety associated with the nosebleed that leads to the elevation in blood pressure

Epistaxis or Nosebleed treatment

For most nosebleeds, simple first aid can usually stop the bleeding.

♦  If you are not feeling faint, sit up and lean slightly forward.
♦  With a finger and thumb, pinch the lower fleshy end of the nose completely blocking the nostrils. It is useless to put pressure over the root of the nose or nasal bones. Usually, if you apply light pressure for 10-20 minutes, the bleeding will stop.
♦  If available, a cold flannel or compress around the nose and front of face will help. The cold helps the blood vessels to close down (constrict) and stop bleeding.
♦  Once the nosebleed has stopped, do not pick the nose or try to blow out any of the blood remaining in the nostrils. This may cause another nosebleed.
♦  If you feel faint it is best to lie flat on your side.

Get medical help quickly if bleeding is heavy, or it does not stop within 20-30 minutes. Sometimes, to stop the bleeding, the nose needs to be packed by a doctor. Rarely, a nosebleed is so heavy that a blood transfusion is needed, and surgery may be required to stop it.