Nose Injury

• Injuries to the inside or outside of the nose

Types of Nose Injuries

• Nosebleed. Even minor nose injuries cause a nosebleed. The bleeding will stop with the correct technique. If the bleeding persists, the child needs to be seen.
• Swollen Nose. Swelling and bruising of the outer nose without a fracture is common. It can be mistaken for a broken nose. The swelling will be gone in 4 or 5 days. Then the shape of the nose will look normal. But the bruising may take 2 weeks to clear.
• Fracture of the Nose. Severe fractures of the nose (crooked nose) are usually reset the same day. This requires surgery in the operating room. Most surgeons don't repair mild fractures until 5 to 7 days after the injury. Caution: a nasal fracture must be re-set before 10 days.
• Nasal Septal Hematoma (Serious). A blood clot of the central wall of the nose. It needs to be drained. If not, there's a risk of cartilage damage. That would lead to a deformed nose.

Call 911 Now

• Major bleeding that can't be stopped
• Passed out (fainted) or too weak to stand
• You think your child has a life-threatening emergency

Go to ER Now

• Bleeding that won't stop after 20 minutes of squeezing the nose correctly
• Foreign object in the nose and can't get out
• Large deep cut that will need many stitches

Call Doctor or Seek Care Now

• Nosebleed that won't stop after 10 minutes of squeezing the nose correctly
• Pointed object put in the nose and caused pain or bleeding
• Skin is split open or gaping and may need stitches
• Severe pain and not better 2 hours after taking pain medicine
• Deformed or crooked nose (not just swelling)
• Skin is cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
• Breathing through the nose is completely blocked
• Age less than 1 year old
• Nose becomes infected (fever, a yellow discharge, redness)
• You think your child has a serious injury
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Shape of the nose has not come back to normal after 4 days
• Dirty cut or hard to clean and no tetanus shot in more than 5 years
• Clean cut and no tetanus shot in more than 10 years
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• You have other questions or concerns

Self Care at Home

• Minor nose injury

Care Advice for Minor Nose Injury

1. Nosebleed - How to Stop:
   • To stop a nosebleed, squeeze the soft parts of the lower nose together. Gently press them against the center wall.
   • Do this for 10 minutes to put pressure on the bleeding point.
   • Use the thumb and index finger in a pinching manner.
   • If the bleeding continues, move your point of pressure.
   • Have your child sit up and breathe through the mouth during this procedure.
2. Skin Bleeding - How to Stop:
   • For any skin bleeding, put direct pressure on the wound.
   • Use a gauze pad or clean cloth.
   • Press for 10 minutes or until the bleeding has stopped.
3. Clean the Cut:
   • After the skin bleeding has stopped, wash the area. Clean with soap and water for 5 minutes.
   • If a large area, use an antibiotic ointment (such as Polysporin). No prescription is needed.
   • Then, cover with a bandage (such as Band-Aid) for 1 day.
4. Cold Pack for Pain:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the nose for 20 minutes.
   • Repeat in 1 hour, then as needed. Caution: Avoid frostbite.
5. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
6. Concerns About Missing a Minor Nasal Fracture:
   • If a swollen nose is the only finding, usually it's not broken.
   • Even if it's broken, standard practice is to delay correction for a few days. This allows the swelling to go away. Reason: The swelling interferes with seeing the shape of the nose.
   • X-rays are often not helpful. Reason: Most of the nose is cartilage. Injuries to the cartilage do not show up on X-ray.
   • Looking at the nose after the swelling is gone is preferred. You can usually do this by day 4 or 5. This is the best way to tell if it is fractured. It will look different than it used to. Delayed correction also helps the surgeon better see what needs to be corrected.
   • Caution: If the nose is broken, a surgeon must re-set it. This should be done before the 10th day.
7. What to Expect:
   • Nose pain and swelling usually peak on day 2.
   • They go away over 3 or 4 days.
8. Call Your Doctor If:
   • Pain becomes severe
   • Nasal passage becomes blocked
   • Shape of the nose has not come back to normal after 4 days
   • Signs of infection occur (a yellow discharge, more tender to touch or fever)
   • You think your child needs to be seen
   • Your child becomes worse