Nosebleeds are not usually dangerous, but they are messy and alarming.

In order to stop the bleeding, a clot must form.  The quickest way is to have the child sit calmly, with the head tilted slightly forward (as if looking at the floor at the far end of the room).  Pinch both nostrils closed, and hold them closed for 10 minutes or longer, while the child breathes through his mouth.

Pinching the nostrils creates a closed cavity; the blood flows forward into the cavity and sits, forming a clot.

Do not tilt the head backward; if you do, the blood will flow back, down the throat.  No clot forms, and the child will swallow the blood, which may cause a stomache upset.

Do not open the nostrils before waiting the full 10 minutes.  If you do, the partly-formed clot will dislodge, and the process must start again.

If the nosebleed does not stop within an hour or so, you may need to go to an Emergency Room to have the bleeding cauterized.  (Keep the head down and the nose pinched on the trip there - maybe the bleeding will stop!).

--  Now that the bleeding has stopped, you can think about how this happened.

Was the nosebleed caused by a blow to the face?  The child should see an ENT surgeon within a few days if nasal stuffiness persists (indicating a possible hematoma).   If the tip of the nose is pushed to one side (when viewed from the chin with the face turned up), there may be a dislocation ("broken nose") that requires a visit to an ENT surgeon.  "Raccoon eyes" (bruising around the eyes a couple of days later) may also indicate a nasal fracture.

Are the nosebleeds recurrent?  Treating the child's chronic hay fever, avoiding cigarette smoke, using a humidifier, and using saline drops in both nostrils twice a day can reduce the frequency and severity of nosebleeds.

Does the child always bleed from the same nostril?  If so, there may be a "bleeder" inside the nose that an ENT can cauterize.

Is there commonly other bleeding or bruising noted, such as when brushing the teeth or with stools?  If so, there may be a disorder of blood clotting that would need medical attention.

If the nosebleeds seem severe, last excessively long, or are increasing in severity and frequency, please give us a call!

     --  David M. Epstein, MD

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