Nosebleeds 101

What is a Nosebleed?

The nose contains many blood vessels. Nosebleeds occur when one of these blood vessels opens and releases blood that flows out of the nose. Nosebleeds can be minor where only a few drops of blood are present or severe requiring visits to a health care provider.

Nosebleeds in Children

Bleeding from the nose in children commonly occurs from the front part of the nose in and area called the nasal septum. The septum divides the left and right side and has a network of delicate blood vessels that can easily open. These blood vessels lie close to the surface and help with normal nasal function.

For most healthy children, nosebleeds stops with less than 15 minutes of applied pressure. While it might scare parents to see a child bleeding from his or her nose, in this case not enough blood is lost to be considered serious and can be cared for by the parent or caregiver. 

• In a minority of children, bleeding may occur as clots and may last for about 30 to 40 minutes. This is usually seen in older children or older adults. These can occur from the front or back of the nose.

Other reasons why your nose may bleed:

• A family history of nosebleeds may be present.
• Nosebleeds are very common in children ages 3 –11 and may be due to nose picking or prior trauma.
• Nosebleeds in teenage boys does require special attention due to the risk of a rare nasal tumor that occurs in this population.

Are nosebleeds normal?

Occasional nosebleeds are a normal childhood occurrence.

Nosebleeds in infants are rare. If there are other nasal symptoms such foul smelling drainage on one side or difficulty breathing, a physician should be consulted. 

What causes nosebleeds in children?

Most children’s nosebleeds are caused by dry air – either from living in a dry climate or the heated air inside the home – and picking or scratching inside the nose. It has also been shown that allergies and air pollution can contribute to nosebleeds. 

These other factors may also contribute to nosebleeds:

• External injury to the nose such as getting hit.
• Putting an object inside the nose.
• Nose blowing – repeated and blowing too hard – due to having conditions such as a cold, the flu, pneumonia or allergies.
• If a clot that has formed from a previous injury or nosebleed comes off.
• Nasal medications, either from drying of the nose or from improper use (nasal sprays should be aimed toward the side of the nose and not the midline where the septum is).

Uncommon causes of nosebleeds in children might result from: 

• Use of drugs that interfere with blood clotting, such as aspirin
• Having medical conditions such as
  • Leukemia
  • A nasal tumor or other abnormal tissue growth that may be noncancerous or cancerous
  • Blood clotting or blood vessel disorders such as the genetic disorder Hereditary Hemorrhagic Telangiectasia (HHT), with which blood vessels do not develop normally leading to bleeding that can be serious or life threatening

How to stop nosebleeds in children

Use these tips if your child is having a nosebleed:

• Keep your child calm to avoid causing more bleeding.
• Have the child sit with the head leaning forward slightly, not backwards.
• Either the child or parent should pinch the nostrils tightly closed at the soft part of the nose just below the nasal bone. Maintain this for up to 15 minutes.
• Leave any blood crusts in place and don’t let the child blow his or her nose for several hours so the nosebleed does not start again.

Call your child’s primary care pediatrician if bleeding does not stop after 15 minutes of pinching the nostrils. 

How to prevent nosebleeds in children

Use these tips to prevent nosebleeds in children:

• Use a humidifier and nasal saline in dry environments to keep nasal passages moist.
• Avoid using fingers to pick at your nose.
• Keep your child’s fingernails short to discourage nose picking.
• Apply a thin layer of petroleum jelly inside the nostrils for moisture.
• Address allergies or colds with proper treatment.
• Teach children gentle nose care to avoid injury.

Some patients will respond to using saline sprays and petroleum jelly such as Vaseline or topical antibiotic ointments that help prevent the nose from getting too dry. It is usually recommended that Vaseline ointment be applied two times every day.

When should a child see a pediatrician for nosebleeds?

A pediatrician can help families manage the child’s nosebleeds conditions.  

See your child’s doctor if:

• The bleeding goes on for more than 15 minutes
• The bleeding was caused by an injury, which may be a sign of internal bleeding
• The child may have put something in their nose
• The child is having trouble breathing
• The child having the nosebleed is under age 2
• The child is on a course of aspirin or blood thinning medicine
• The child has frequent nosebleeds
• The child has other areas of the body with easy bleeding or bruising 

If the bleeding doesn’t stop on its own or when pressure is applied, the pediatrician may recommend medication such as topical antibiotics.

When should a child see a specialist for nosebleeds?

If the pediatrician thinks that the nosebleed is a symptom of something more complex, they will refer the child to a specialist. 

The main role of an Ear, Nose and Throat Specialist is evaluating children who continue to bleed despite conservative measures. The pediatric specialist will: 

• Review conservative measures that have been taken and educate on other measures.
• Evaluate structural reasons for nosebleeds. To do this sometimes a flexible camera to look at the back of the nose is needed.
• Consider procedures such as cauterization where a controlled application of a chemical can seal the blood vessel causing nosebleeds. Cauterizations sometimes must be done under general anesthesia.
• Order further testing, especially in cases where there is a concern for a bleeding disorder.

Expert Care at Texas Children’s Hospital in Houston and Austin

For your convenience, Ear, Nose and Throat (Otolaryngology) at Texas Children’s provides care at multiple locations across the greater Houston area and in Austin.

Nosebleeds FAQ

Visit Texas Children’s health resources for FAQs about Nosebleed (Epistaxis) in Children.

Nosebleed Resources

Information on Nosebleeds from the National Institutes of Health, MedlinePlus 

Clinical Practice Guideline: Nosebleed (Epistaxis), published in the medical journal Otolaryngology – Head Neck Surgery, 2020 Jan;162(1_suppl):S1-S38. Authors: Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, Lin KW, Lind MM, Poetker DM, Riley CA, Schneider JS, Seidman MD, Vadlamudi V, Valdez TA, Nnacheta LC, Monjur TM.