Nosebleeds in Kids

Nosebleeds happen when the tissue lining the inside of your child’s nose bleeds. A nosebleed usually only affects one nostril, but it can occur in both. The medical term for a nosebleed is epistaxis (pronounced “eh-puh-stak-suhs”).

Your child’s nose is home to many tiny blood vessels that moisten the air they breathe. These vessels are helpful, but they’re close to the inner surface of your child’s nose. Air moving through their nose can dry out and irritate these blood vessels. That makes them very likely to break, which can lead to a nosebleed.

Nosebleeds are very common among kids. They affect 3 out of every 10 children before the age of 5. But these episodes can be alarming both for you and your child. The good news is that nosebleeds are usually minor and go away with at-home treatment. If your child gets a lot of nosebleeds, it’s worth a trip to their pediatrician’s office to find out what may be causing them.

When to worry about a child’s nosebleed

Take your child to the nearest urgent care clinic or emergency room (ER) for a nosebleed if:

• The bleeding is severe or won’t stop.
• Their nose is bleeding after a serious injury.
• They’ve recently had nasal surgery.

Your child also needs immediate care if they have a nosebleed along with serious symptoms, like:

• Coughing up or vomiting blood
• Paleness
• Fatigue
• Confusion
• Trouble breathing
• Chest pain

Symptoms of nosebleeds

Most nosebleeds won’t cause any symptoms besides blood running from your child’s nose. If your child has any other symptoms, it may be a sign of a health condition. Talk to their pediatrician if you have any concerns.

Childhood nosebleeds causes

One of the most common causes of bloody noses in kids is irritation from dry or cold air. When your child breathes in this air, it can irritate and break the blood vessels lining their nostrils.

Even minor traumas — something as simple as picking their nose or blowing it too hard — can cause your child to develop a nosebleed. They may also injure themselves by sticking a small object (like a bead) in their nostril. Or they may get facial trauma from a hit to the nose, a fall or a bike accident.

Other causes of childhood nosebleeds include:

• Common cold or allergies: Minor illnesses and other health conditions can cause your child’s nose to swell, leading to irritation and bleeding.
• Low humidity: If you live in an arid climate, the low levels of humidity can dry out the lining of your child’s nose.
• Exposure to toxic fumes: Irritating fumes like cigarette smoke, bleach and ammonia can dry out the inner surface of your child’s nostrils.

Rare causes of nosebleeds in kids include:

• Blood clotting issues
• Bleeding disorders
• Blood vessel abnormalities
• Polyps or tumors

Risk factors

Childhood nosebleeds are common. More than half of all children in the U.S. will experience one by the time they turn 10. But your child is more likely to have one if they:

• Live in a dry or cold climate
• Use steroid nose sprays for allergies
• Have a chronic illness that requires the use of extra oxygen
• Pick their nose

How doctors diagnose nosebleeds in kids

If your child gets a nosebleed, you usually don’t need to seek medical care right away. But if you can’t get the bleeding to stop, take your child to the nearest urgent care clinic or ER.

A healthcare provider will do a quick physical exam. They’ll ask if the blood is coming from one or both nostrils and if your child has any other symptoms. They’ll check your child’s airway to make sure they’re not having trouble breathing. They’ll also take your child’s vital signs. If it’s an emergency, treatment will start immediately.

If the provider determines that your child’s nosebleed isn’t an emergency, they’ll do a more detailed exam. They’ll ask about your child’s medical history and biological family history. They’ll want to know if your child has any allergies and if they’re taking any medications. They may also ask you questions like:

• When did the bleeding start?
• What have you done to try to stop the bleeding?
• How often does your child get nosebleeds?
• Does your child frequently pick their nose or stick things up it?
• Have they experienced any recent trauma to their face?
• Have they recently had nasal surgery?

The healthcare provider may then apply a medication that can control the bleeding. They’ll either apply it with a spray bottle or place a piece of cotton soaked with the medication into your child’s nostril. They’ll remove it after five minutes. Some children may also need a sedative to relax them. The provider will then thoroughly exam your child’s nose.

Tests that are used

Most children don’t need any lab testing. The provider may request a blood test if:

• The bleeding lasts for more than 30 minutes.
• Treatment doesn’t stop the bleeding.
• Your child gets frequent nosebleeds.

Depending on the cause, the provider may order blood work or imaging tests like a facial X-ray, CT scan with contrast (dye) or MRI.

What is the proper care for a child who gets a nosebleed?

If your child gets a nosebleed, they may be scared and upset. The first step is to calm them down. Try to distract them and let them know that it’s going to be OK. Once they’ve calmed down, have them sit and bend forward slightly. Despite what you may have heard, you don’t want them to lie down or tilt their head back.

To stop the nosebleed, gently pinch the soft area near the openings of your child’s nostrils. Squeeze their nose shut for 10 to 15 minutes. Don’t “peek” to see if it’s still bleeding during that time. If you do, you may loosen the clot that’s forming. If there’s still bleeding, squeeze for another 10 minutes.

If your child’s nose is still bleeding after 30 minutes, it’s time to take them to an urgent care clinic or the emergency room.

How do healthcare providers treat nosebleeds in kids?

If you need to take your child to urgent care or the ER, a healthcare provider can try several things to stop their nosebleed. Treatment may include:

• Vasoconstrictor nose spray: A nasal spray like oxymetazoline can narrow blood vessels, which reduces the blood flow to your child’s nostrils.
• Nasal cautery: A healthcare provider will seal off the bleeding vessels with a chemical like silver nitrate or an electrical device.
• Nasal packing: A healthcare provider will pack your child’s nose with gauze, foam or a sponge-like material to help stop the bleeding.

What is the outlook (prognosis) for children who get nosebleeds?

Nosebleeds in children are usually nothing to worry about. Most of the time, they go away on their own or with at-home care.

Frequent nosebleeds affect 9 out of every 100 children. But with time, these tend to resolve. Children older than 14 typically don’t continue having repeated nosebleeds.

Can nosebleeds in kids be prevented?

Sometimes, yes. To help your child avoid nosebleeds, make sure to keep them hydrated. You can also:

• Use a humidifier: A humidifier makes the air in your home less dry. It can help maintain the humidity level to prevent your child’s nasal passages from drying out.
• Avoid nasal trauma: Make sure to keep your child’s fingernails closely trimmed. But also tell your child not to pick their nose.
• Keep your child’s nose moist: Use a saline nasal spray every day. Or put a dab of petroleum jelly (like Vaseline®) in each nostril at night.

If your child gets frequent nosebleeds, their pediatrician may refer you to an ear, nose and throat doctor (ENT).