Patient's question:
Why does my child always have nosebleedsDoctor's answer:
Minor nosebleeds are usually no big deal, at most they can stain clothes and be unsightly. However, if a child has frequent nosebleeds recently, or if the bleeding won’t stop despite pinching and pressing, what should be done???Babies held in arms rarely get nosebleeds. As children grow and their wings become stronger, their nostrils turn into toys for their small fingers. They poke and prod inside, eventually poking out blood. Dr. Michael Ng, Associate Professor of Otolaryngology at the Department of Surgery, The Chinese University of Hong Kong, points out that the causes of nosebleeds in children are usually minor capillary bleeding. This is because children’s nasal mucosa is thinner, and the anterior part of the nasal septum is a common site for capillary clusters and bleeding.
Recurring nosebleeds indicate a problem
??Dr. Ng explains that the capillaries inside the nose help regulate air temperature and protect the trachea from cold damage. In winter, when the temperature drops, the nasal blood vessels expand to warm the air entering the trachea. As the vessels expand, their walls thin, making them more prone to breaking and bleeding. Additionally, in dry environments, the nasal mucosa can crack like dry skin, making it easy to tear.
??However, if a child has frequent nosebleeds or if proper pressure techniques fail to stop the bleeding, parents should not take it lightly. Dr. Ng notes that if a child has nosebleeds repeatedly within a week or for more than three weeks, it could be a sign of the following issues:
●Irritation from scabs forming on nasal wounds, causing discomfort. If children can’t resist scratching the wound again, it leads to further bleeding, creating a vicious cycle.
●Nasal itching due to respiratory allergies.
●Local vascular fragility.
●Problems with the blood clotting system.
●A deviated nasal septum that protrudes and causes air to flow backward, making it especially prone to bleeding. Severe nosebleeds that last more than fifteen minutes may indicate posterior septal bleeding. Because the nasal bone obstructs the septum, pressure techniques cannot stop the bleeding by pressing the bridge of the nose, making it difficult to control. The causes of posterior septal bleeding may include:
●Excessive force during nose blowing, causing injury to the posterior septum.
●Trauma to the nose from collisions.
??In such cases, it’s essential to seek medical attention. Dr. Ng explains that doctors can identify the wound and apply silver nitrate to block the blood vessel opening, allowing the wound to heal within four to seven days. If the wound is at the back of the nose, medication-soaked gauze or compressed sponge with vasoconstrictive and anti-inflammatory properties may need to be inserted to stop the bleeding. In some cases, an otolaryngologist may even need to use an endoscope to locate the bleeding point.
Correct nosebleed stopping techniques
??Flow—Nose—Blood—Oh!
??Said: “Tilt your head back, let the blood flow into your stomach, don’t waste it.”
??Mom said: “Lean forward, pinch your nose bridge.”
??Dr. Ng says both methods are incorrect. Tilting the head back may seem to stop the bleeding, but in reality, the blood flows down the throat. It enters the esophagus and stomach, irritating the gastric mucosa and causing discomfort or vomiting. If a large amount of blood accumulates in the throat, it can obstruct the airway, leading to breathing difficulties or even suffocation, which is dangerous.
??As for pinching the nose bridge, it doesn’t help stop the bleeding. Dr. Ng explains that the bleeding point is usually at the front of the nose, so pinching the bridge is ineffective. For anterior septal bleeding, the first step is to stay calm, keep the head straight or slightly forward, and press both sides of the nostrils (as if pinching the nose) for five to ten minutes. Breathe through your mouth during this time (correct pressure technique—don’t breathe through the nose). If the bleeding doesn’t stop after fifteen minutes, seek medical attention.
Four major causes of nosebleeds
Anterior septal bleeding—50%
Nasal trauma—25%
Systemic diseases—20%
Tumors—5%