"My five-year-old son gets nosebleeds often. At first, he got them only at night. Then they started occurring during the day for no apparent reason. I've used all the methods to try to stop the bleeding, but it frequently takes 15 to 20 minutes to stop it. Why is he getting them and how can they be stopped once and for all?" she implored me shortly after I entered the examining room. This is a very common entreaty that I face several times each week.
The most common cause of nosebleeds in this age group is nose picking. During sleep, the child's nose gets dry and itches. He puts his finger in his nose to scratch and, unless the nails are very short, the lining of the nose is injured. A scab forms over the injury site, only to be knocked off the next time the finger enters the nose. Finally, the area is so damaged and the scab so large that it comes off during sneezing or sniffing. Each time this scab comes off, bleeding is profuse.
Nosebleeds can be associated with other conditions such as hay fever, nasal infections, conditions associated with impairment of blood clotting, high blood pressure, and congenital abnormalities of the capillaries in the nose. If the nosebleeds continue, it is wise to have the child checked by a physician to be sure the signs and symptoms of the above-mentioned causes are not present. We must remember that all of these conditions are far behind nose picking as causes in this age group. It is also important to have him checked for anemia if the blood loss was heavy and recurrent.
The treatment of nosebleeds is twofold: 1) the acute bleeding must be stopped, and 2) measures must be taken to allow the scratch to heal. I find most people do everything but the right thing to stop the bleeding. People use methods from ice at the base of the neck to a piece of brown paper sack under the upper lip in hopes the flow can be stopped. The only way to effectively stop this type of nosebleed is to pinch the soft part of the nose tightly and hold it continuously for three minutes. If you let go to check, it will usually keep bleeding and the three-minute time period starts over. To reduce the blood flow to the head have the patient sit up rather than lie down while you are applying pressure. Packing the nose with gauze should be used only if pressure is ineffective and this should be done by someone trained in the procedure. Simply stuffing cotton or Kleenex in the nose is of no use.
To end the problem, the scab must remain undisturbed for several days. If the damage is deep, the area may need cautery by a physician. As a general rule, if one cuts the fingernails short and applies a Vaseline-type ointment around the opening of the nose to keep the scab soft, the tissue heals and the bleeding ceases. Some parents resort to tying the child's hands so that he cannot reach the nose. I find this method too emotionally disturbing for any child and feel it should not be done. Putting socks over the hands is usually not effective because children are very clever at removing such covers in their sleep. The best treatment is prevention. The best prevention is keeping your child's fingernails short.