My Child Gets Nosebleeds Often

"It happens in their sleep, in the morning, even while washing their face. What could be wrong?"

Parents who come in about a child's nosebleed usually arrive already alarmed. The blood looks like a lot, the child is crying, and you will have wondered whether it is the sign of some serious illness.

There is something I want to say first. A child's nosebleeds usually come from the same spot. Once you know that spot, both why they come often and how to stop them come undone together.

Nosebleeds do not come from just anywhere

The wall dividing the two nostrils is called the nasal septum. At the front of it there is a place where fine blood vessels gather like a net. It is called Kiesselbach's plexus, after the person who found it.

The conditions at this spot are not good. The vessels run shallow just beneath the lining, it is close to the entrance of the nostril and so the place a finger reaches most easily, and it is a spot that dries easily as breath moves in and out. Most nosebleeds come from here.

For children it is more so. The lining is thin, and when the nose itches they do not hold back — they touch it.

If they come often, that spot is always raw

A spot that has burst once forms a thin scab. That scab itches. The child touches it, touching makes it burst again, and another scab forms. Frequent nosebleeds are often not a newly formed wound but one spot that cannot heal.

If a condition of the inside of the nose always being swollen is layered on top of this, the loop grows firm. With allergic rhinitis or a lingering head cold, the lining swells, becomes congested, and itches. The vessels stand out more, the itch means more touching, and the swelling means it bursts more easily.

Nosebleeds clustering in a dry season is for the same reason. A dried-out lining tears easily.

So what I look at

Stopping the nosebleed itself is usually not difficult. What I look at is why that lining has no room to heal.

Whether the nose is always blocked so the child breathes through the mouth, whether there is sneezing and clear nasal discharge every morning, whether there is a habit of rubbing the nose often — these are what I ask about. The nosebleed is the result, and the place to work on is usually ahead of it.

I go toward settling the swollen lining, getting fluid to move through the dried spot, and keeping the nose from blocking at night. When the inside of the nose is comfortable the child touches it less, and only when it is touched less does that spot heal.

When a nosebleed happens — the spot and the time are the knack

There are cases where parents say it does not stop well even with pressure. Sometimes the spot being pressed is a little too high.

The place the blood comes from is below the firm part of the bridge of the nose, at the soft part just above the nostrils. You have to hold below that for that spot to be pressed.

• Hold the soft part just above the nostrils between thumb and index finger
• Keep pressing for about 15 minutes. Letting go partway to check whether it has stopped starts it over
• Have the child spit out the blood that comes through rather than swallow it. Swallowing makes the stomach queasy

Whether to tilt the head forward or back is set out as being not as important as it is commonly said to be. Still, tilting back makes the blood pass into the throat and easy to swallow, so leaning a little forward is more comfortable. What matters is not the angle but the spot pressed and the time.

When to see a doctor first

If it does not stop even after pressing properly for over 15 minutes, if it pours from both nostrils at once, if it came after a knock, or if besides the nosebleed the gums bleed and the body bruises easily — it is better to be seen first.

Otherwise, if the child is playing well and eating well, it is not common for frequent nosebleeds in themselves to mean a serious illness. Still, there is a reason they come often, and that reason is usually inside the nose.

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Sources

• A summary that nosebleeds come mainly from the vascular plexus at the front of the nasal septum, and that the spot pressed and the time are the knack — Asan Medical Center, Department of Family Medicine
• A summary that finger irritation and dryness are common causes in anterior nosebleeds in children — The Ochsner Journal, 2010

Written by Dr. Heo Ji-young (Ph.D. in Korean Medicine Pathology, Kyung Hee University · former Research Professor of Herbology, Kyung Hee University)