Nosebleed

• Bleeding from 1 or both nostrils
• Not caused by an injury

Causes of Nosebleeds

Nosebleeds are common because of the rich blood supply of the nose. Common causes include:

• Spontaneous Nosebleed. Most nosebleeds start up without a known cause.
• Rubbing or picking the nose is the most common known cause. It's hard to not touch or rub the nose.
• Blowing the nose too hard can cause a nosebleed.
• Suctioning the nose can sometimes cause bleeding. This can happen if the suction tip is put in too far.
• Sinus Infections. The main symptoms are lots of dry snot and a blocked nose. This leads to extra nose blowing and picking. The sinus infection is more often viral than bacterial.
• Nose Allergies. The main symptom is a very itchy nose. This leads to extra rubbing and blowing.
• Dry Air. Dryness of the nasal lining makes it more likely to bleed. In the winter, forced air heating often can dry out the nose.
• Allergy Medicines. These help the nasal symptoms, but also dry out the nose.
• Ibuprofen and Aspirin. These medicines increase the bleeding tendency. Aspirin is not used in children.
• Bleeding Disorder (Serious). This means the blood platelets or clotting factors are missing or not working right. A bleeding disorder should be suspected if the nosebleed can't be stopped. Excessive bleeding from the gums or with minor cuts is also a clue. Bleeding disorders are a rare cause of frequent nosebleeds.

Call 911 Now

• Passed out (fainted) or too weak to stand
• You think your child has a life-threatening emergency

Go to ER Now

• Bleeding a lot after 20 minutes of squeezing the nose correctly

Call Doctor or Seek Care Now

• Nosebleed that won't stop after 10 minutes of squeezing the nose correctly
• Large amount of blood has been lost
• New skin bruises or bleeding gums not caused by an injury also present
• High-risk child (such as with low platelets or other bleeding disorder)
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Age less than 1 year old
• New onset nosebleeds happen 3 or more times in a week
• Hard-to-stop nosebleeds are a frequent problem
• Easy bleeding is present in other family members
• You have other questions or concerns

Self Care at Home

• Mild nosebleed

Care Advice for Nosebleed

What You Should Know About Nosebleeds:

• Nosebleeds are common.
• You should be able to stop the bleeding if you use the correct technique.
• Here is some care advice that should help.

Squeeze the Lower Nose:

• Gently squeeze the soft parts of the lower nose together. Gently press them against the center wall for 10 minutes.  This puts constant 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.
• If rebleeds, use the same technique again.

Put Gauze into the Nose:

• If pressure alone fails, use a piece of gauze. Wet it with a few drops of water. Another option is to put a little petroleum jelly (such as Vaseline) on it.
• Insert the wet gauze into the side that is bleeding. Press again for 10 minutes. Reason it works: the gauze puts more pressure on the bleeding spot.
• Special nose drops: if your child has lots of nose bleeds, buy some decongestant nose drops. An example is Afrin. No prescription is needed.  Put 3 drops on the gauze and press. Do this once. The nose drops also shrink the blood vessels in the nose.
• Caution: don't use decongestant nose drops if your child is under 1 year of age.
• If you don't have gauze, use a piece of paper towel.
• Repeat the process of gently squeezing the lower soft parts of the nose. Do this for 10 minutes.

Prevent Recurrent Nosebleeds:

• If the air in your home is dry, use a humidifier to keep the nose from drying out.
• For nose blowing, blow gently.
• For nose suctioning, don't put the suction tip very far inside. Also, move it gently.
• Do not use aspirin and ibuprofen. Reason: increases bleeding tendency.
• Bleeding areas in the front of the nose sometimes develop a scab. It may heal slowly and re-bleed. If that happens to your child, try this tip. Apply a small amount of petroleum jelly (Vaseline) to the spot. Repeat twice a day. Do not use for more than 1 week.

What to Expect:

• Over 99% of nosebleeds will stop if you press on the right spot.
• It may take 10 minutes of direct pressure.
• After swallowing blood from a nosebleed, your child may vomit a little blood.
• Your child may also pass a dark stool tomorrow from swallowed blood.

Call Your Doctor If:

• Can't stop bleeding with 10 minutes of direct pressure done correctly
• You think your child needs to be seen
• Your child becomes worse

Care Advice for Nosebleed

• Gently squeeze the soft parts of the lower nose together. Gently press them against the center wall for 10 minutes. This puts constant pressure on the bleeding point.
• Use the thumb and index finger in a pinching manner.
• If the bleeding does not stop, move your point of pressure.
• Have your child sit up and breathe through the mouth during this process.
• If the nose re-bleeds, use the same technique again.