Nosebleeds, also referred to as Epistaxis, are very common this time of year. They can be quite dramatic and a little frightening. Nosebleeds can occur at any age but are most common in children age 2 to 10 and adults age 50-80. Nosebleeds occur most commonly in the morning. Fortunately, most nosebleeds are not serious and can be easily managed.
The nose is a part of our body that is very vascular, i.e. rich in blood vessels, and is situated in a vulnerable position as it protrudes from the face. Nosebleeds are categorized based on where they originate—anterior or posterior. Anterior nosebleeds account for 90% of all nosebleeds. Bleeding from this area usually originates from blood vessels on the nasal septum. Anterior nosebleeds are usually easy to control. Posterior nosebleeds are much less common and tend to occur more often in elderly people.
Most nosebleeds don’t have an obvious cause. Trauma to the nose, such as a blow to the face by a ball or hand, can cause a nosebleed. Other possible causes include:
*exposure to warm dry air for long periods of time (such as a school day!)
*nasal/sinus infections *allergic rhinitis
*picking the nose *vigorous nose blowing
*deviated septum *nasal foreign body
Additional causes (more commonly found in adults) include: blood thinning medications (including aspirin or non-steroidal anti-inflammatory drugs), topical nasal medication, liver disease, inhaled drug use (such as cocaine) and high blood pressure.
Treatment of nosebleeds is simple and effective. First, stay calm! Keep the head higher than the heart (i.e. sit up) and lean forward slightly. Do not lean the head back, as this allows blood to drain into the mouth, throat and stomach—sometimes causing nausea and/or vomiting. Using the thumb and forefinger, firmly pinch all the soft parts of the nose. Use a tissue when pinching to prevent blood contamination. A student is pinching firmly enough if their voice sounds like a cartoon character when they speak! Keep pinching for at least 5 minutes. If still bleeding, continue pinching. If bleeding continues, it is helpful to place an ice pack at the base of the skull while pinching. Vomiting due to swallowed bloody drainage can sometimes occur.
Students with nosebleeds should be sent to the Nurse. We will assess and treat the nosebleed and confirm that bleeding has stopped before sending students back to class. Students who have contaminated clothing will be provided with a change of clothes. After the initial nosebleed has stopped, students are cautioned not to pick or blow their nose and not to strain or bend down to lift heavy items. No fingers in the nose!
To prevent future nosebleeds, a humidifier at home is helpful. Keeping fingernails cut short discourages nose picking, a bandaid applied to the forefinger will help the student remember NOT to pick. Maintaining moisture in the lining of the nose by applying Vaseline, antibiotic ointment, or A&D ointment 2-3 x day is beneficial; use of a saline nose spray (Ocean spray) is also helpful to moisten dry nasal membranes.
A physician should be contacted when bleeding has not stopped after 2 10-minute attempts at pinching the nostrils or nose bleeds occur daily despite efforts to moisturize the nose. Physician should also be notified if there are additional signs of bleeding—skin bruises not caused by an injury, unexplained bleeding from the mouth or gums, or fainting or feeling dizzy when the child stands up.
Schmitt, Barton D., M.D. “Your Child’s Health”