Nose Bleed

Nearly every child will have a bleeding nose sooner or later. During schooldays it’s almost inevitable. There are many causes, and picking and poking and prodding the nose are at the top of the list. It’s incredible how children are attracted to the habit of fiddling with the nose. I’m glad to say most overcome it as they get older.

Nose bleeds can happen as the result of a cold, any kind of nasal infection, allergy, a follow on from infections elsewhere, such as in measles or any other common childhood illness. The inevitable foreign body stuffed into the nose in a clandestine moment is also notorious. Peas, peanuts, dried beans, gravel, bits of plastic or shell have all been incriminated.

Fisticuffs, blows on the nose, inadvertent accidents and falls are also common reasons.

Any recurring nosebleed should be followed by adequate medical attention and investigation. Although uncommon, such disorders as bleeding diseases, bruising disabilities and leukemia (cancer of the blood) may be initiated with bleeding noses. Sometimes it is the first and only early symptom.

Nose Bleed Treatment

  1. Sit the patient up, and suggest that the head be bent forwards.
  2. Loosen any tight clothing (such as neckties, and undo shirt buttons).
  3. Firmly grip the nostrils between the thumb and index finger and maintain firm, even pressure for at least 10 minutes. It may be loosened for a few seconds each couple of minutes, but only momentarily, for bleeding may recommence.
  4. After 10 minutes (preferably by the clock) release grasp, and see if bleeding point has clotted, as evidenced by reduced flow or cessation.
  5. If flow recommences, reapply pressure for further segments of five minutes. If you tire, ask an assistant to resume the pressure.
  6. Do not allow patient to blow the nose at any stage, and suggest that it not be done for a minimum of 2 – 3 hours thereafter (as it will dislodge the clot and further bleeding may occur).
  7. Cold icepacks or wet towels applied to the forehead often make the patient feel better. (Some claim icepacks to the neck and forehead may reflexly assist in reducing blood loss by causing vasoconstriction of vessels.)
  8. Suggest patient mouth-breathe (and continue this for some hours). Correct procedure for arresting nosebleed.
  9. Speak encouraging words, and do not alarm.
  10. Remove blood-stained clothing and packs as early as possible, for these promote fear in a patient, particularly in the case of children.
  11. Make every effort to reduce fear in children, who are always very apprehensive and may cry. Crying will increase blood pressure, and increase risk of fresh bleeding.
  12. Seek further medical treatment, particularly with older patients, if this treatment does not stop bleeding. (Nasal packing may be needed, or it may be the sign of a deep-seated medical disorder that could be serious.)
  13. Sips of cold fluid (preferably icy water) may be given.

The first and most important instruction is to remain calm. So many mothers (especially at night) become very fearful, believing their child will hemorrhage to death. So they panic. Imminent danger is not high. Calmness and reassurance will communicate to the frightened patient, so make every effort to remain relaxed. If you cannot, seek assistance from others, such as your husband or maybe the next door neighbors.

The next step is to sit the patient up, and hold the nose firmly between the thumb and index finger for 10 minutes, by the clock. Do not release every few minutes because you are asked to. It takes quite a time for the blood flow to stop and a clot to form over the break in the vessel. Most cases cease within 10 minutes.

Ideally the patient should not blow the nose for at least 24 hours, for the clot may be disturbed and a fresh bleed commence. Also, do not allow picking or fiddling, for this likewise could cause a new bleed. The bleeding point is usually on the nasal septum just a little way inside the nose, a spot called Little’s area, or Kiesselbach’s area.

Some crushed-up ice in a facecloth applied to the forehead and on the neck is helpful. Also mopping the brow with a cold cloth every few minutes makes the patient feel a lot better. It may not stem the blood flow, but is refreshing. But do not take any risks with chills. It’s easy at night, especially in winter. A good covering is necessary. even though the patient will probably feel hot and sweaty and apprehensive. Care to avoid shock is advisable.

If ice packs fail, it’s then time for medical attention from the doctor or at a hospital. Occasionally the nasal passageways need to be packed with special long gauze strips using an instrument called crocodile forceps. These are simply forceps with a long, blunt end. It allows the pack to extend well back. Occasionally, in serious cases, cauterizing of the bleeding point by an ENT consultant is needed. After this the vessel is obliterated completely and permanently, and rarely will further problems arise. But recurring bouts need a full check for any serious underlying anomaly.