An ENT Mom's Guide to Nosebleeds
Winter is nosebleed season and I have had to deal with my own share of nosebleeds over this past year. My toddler started having nosebleeds last summer. They were sporadic at first and then gradually increased in intensity. Being an ENT resident, I was well equipped with the knowledge and resources to deal with my toddler's nosebleed, yet it was scary at times. I decided to write this article to share my experience with others who might be dealing with an occasional nosebleed.
Most nosebleeds in kids are due to dry air or trauma from nose picking irritating the lining of the septum (the partitioning in our nose). Nosebleeds usually last a few seconds to minutes. If a child has recurrent nosebleeds, the best way to control it is to prevent it by keeping the nose moist. This is done by:
1. Applying lubricating gels or ointment to the nose two to three times daily. There are many over-the-counter products that work great. I prefer saline gels, KY jelly, or Aquaphor. I apply a pea sized amount with a finger to the nostril and have the child sniff in. This carries the gel into the nose.
2. Run a humidifier at home to prevent the air from getting too dry.
3. Teach the child to keep his or her fingers out of the nose.
If this is done consistently, it should stop or significantly reduce the frequency of the nosebleeds. But when a nosebleed happens, to control an acute episode:
1. If the child is old enough to follow instructions, pinch the soft part of the nose and lean forward for 5-10 mins straight, no breaks. This should stop most bleeds. If the child will not sit still, like my son who runs around the house wiping is blood stained face over my stuff, I go to next step.
2. Use some decongestant nasal spray (active ingredient Oxymetazoline), this is also available over the counter. It works by constricting blood vessels. Spray 2-4 sprays to the bleeding nose. Saturate a cotton ball with some of the spray and plug the bleeding nostril with the cotton ball.
This should control a vast majority of nosebleeds. A parent should inform his or her pediatrician of the nosebleed especially if it is a significant bleed that lasts more than a few minutes, when there is a large volume of blood loss, or if the nose bleed happens multiple times. For significant bleeding the causative vessel may need to be cauterized (burned off). This is is done after the ENT doctor looks in the nose to ensure there are no foreign bodies and to rule out other reasons for significant nosebleeds.
Cautery is usually done with silver nitrate. In some kids who are older and able to sit still, it can be done in the office but in younger kids or persons who can't withstand the procedure awake, a trip to the operating room may be required.
My son's nosebleeds were pretty intense, probably the worst I have seen in a 2 year old. They were happening weekly and lasting about 30 mins each time and seemed to be getting worse. He wouldn't let me try any of the controlling measures I described above. He was a messy wild man, running around splashing blood. So, I talked to my attending who agreed to cauterize Tobe's nose. I elected to do it awake in his office because being under 3 years, I wanted to avoid anesthesia. His dad and I had to hold him down while his nose was cauterized. Poor little guy. I do not recommend this route for everyone. Present day anesthesia is very safe and should be utilized to alleviate discomfort.
Since cauterization a month ago, Tobe has been nosebleed free! But nosebleed management is an ongoing process, even with cauterization. Ointments and humidification have to be continued. We apply Tobe's ointment after he sleeps at night and during nap times. Nosebleeds may recur even after cauterization but if they do, they are usually less severe and less often.
***Please note that this discussion does not constitute medical advice***
***This is just me sharing my experience and things I do. You should consult your doctor with any concerns you might have about a nosebleed.***
***This blog post is not an ad and is not affiliated with any company or product. There was no monetary gain to writing this***