Nosebleeds (Epistaxis)


Nosebleeds (Epistaxis)

Nosebleeds in children are common. A nosebleed is loss of blood from the tissue that lines the nose. Bleeding most commonly occurs in only one nostril. Nosebleeds can be scary and messy, but are rarely life threatening.

The nose contains many small blood vessels that bleed easily. Air moving through the nose can dry and irritate the membranes that line the inside of the nose, forming crusts. These crusts bleed when irritated by rubbing, picking, or blowing the nose.

30% of children younger than 5 and 56% of those aged 6 to 10 years have had at least one nosebleed.

Patients can be seen by Texas Children's experts in Ear Nose and Throat (Otolaryngology).

Causes & Risk Factors

Causes and risk factors:

  • Low humidity
  • Allergies
  • Colds
  • Minor irritation in the nose
  • Sinusitis (sinus infection)
  • Deviated septum
  • Frequent picking of the nose
  • Foreign object in the nose or other nasal blockage

Nosebleeds happen more often in the winter when viruses are common and heated indoor air dries out the nostrils.

Symptoms & Types

Symptoms include:

  • Bleeding from the nostrils, usually from only one
  • Bleeding can occur from both nostrils if it is heavy enough
  • Spitting out blood or even vomiting can occur if bloods drips back into the throat or down into the stomach

Excessive blood loss from nosebleeds does not happen often. Signs of excessive blood loss include:

  • Dizziness
  • Light-headedness
  • Confusion
  • Fainting 

Diagnosis & Tests

If your child experiences severe bleeding or frequently has nosebleeds, see your pediatrician.

During the examination, the doctor will ask questions about the bleeding. These questions may include:

  • How much bleeding?
  • How frequently does your child experience nosebleeds?
  • Do the nosebleeds stop quickly when you press on the nostrils?
  • Does the bleeding occur in one or both nostrils?

Your doctor may also ask questions about other symptoms:

  • Is there blood in the stools?
  • Has your child been vomiting blood?
  • Does your child bruise or bleed easily?
  • Are there tiny red or purple spots on the skin (petechiae)?
  • Is there a family history of bleeding disorders?

Again, most nosebleeds are not serious. If your child's doctor feels more answers are needed, you may be referred to an ear, nose and throat doctor (an otolaryngologist).

Treatment & Care

To stop the bleeding:

  • Have your child sit down.
  • Gently squeeze the soft portion of the nose between your thumb and forefinger (so that the nostrils are closed) for a full 10 minutes.
  • Have your child lean forward to avoid swallowing blood, and breathe through the mouth.
  • Apply a cold compress or ice across the bridge of the nose.
  • Do not pack the inside of the nose with gauze.

Wait at least 10 minutes to see if the bleeding stops. Many nosebleeds can be controlled this way if enough time is allowed for the bleeding to stop.

Once the bleeding stops, you should:

  • Increase the moisture to the nose by using salt water nose drops often, at least twice a day.
  • Use a humidifier at night time.
  • Apply an over-the-counter antibiotic ointment, like Neosporin®, twice a day to the front of the nasal septum. This is particularly important before bed.

Living & Managing

Nosebleeds usually look worse than they actually are. Some nosebleeds may be serious, however. These cases are not common, but you want to be sure that your child does not have one of the serious cases. If your child has frequent nosebleeds or a nosebleed lasts for a long time, make an appointment with your pediatrician.