Nosebleeds (epistaxis) are a common childhood condition, that are usually self-limiting and one that children normally grow out of by around 11 years of age. They are commonly caused by minor injury to the lining of the nose, and this can be caused by picking or banging the nose. They can also occur if your child has had a recent cough or runny nose (viral upper respiratory tract infection), if they have allergic rhinitis, blowing the nose too hard, if the inside of the nose becomes too dry or by a foreign body in their nasal passage. Only very rarely can it be due to a bleeding disorder. The bleeding is usually from the front part of the nose and whilst the amount of bleeding may seem like a lot (such as soaking through tissues), it is rare for children to lose so much blood that it causes any problems (such as anaemia). This is only to be likely with frequent, heavy nosebleeds over several weeks or months.
The advice below should help you decide whether your child’s nosebleed requires further help or whether it can be managed by yourself at home.
When should I worry and what should I do?
Call 999 or go to A&E now if your child:
- If your child is on medication that prevents blood clotting (such as warfarin, heparin or aspirin)
- If the nosebleed has been ongoing for more than 20 minutes despite appropriate first aid
- If the nosebleed is from both nostrils (this suggests a nosebleed from the back of the nasal passageway)
- If despite sitting your child upright and getting them to lean forward, they are choking on the blood (this suggests a nosebleed from the back of the nasal passageway)
- If your child has significant disfigurement to their nose after injury to the face
- If your child is experiencing any difficulty in breathing
- If your child has a condition that means that their blood cannot clot properly, such as haemophilia
Call 111 or ask for an urgent GP appointment if your child:
- If there is a discharge from the nose alongside the nosebleed (as this may be due to a foreign body in the nose)
- If your child has frequent small-volume nosebleeds that respond to first aid
- If your child has nose bleeds and bruised skin anywhere on the body or a family history of a bleeding disorder
You can also contact your nearest Walk-in Centre.
If none of the above symptoms are present:
- Care using the advice below can be provided to your child at home if none of the above features is present
- If your child continues to get frequent nose bleeds, please arrange to speak to your GP or practice nurse
First aid for nosebleeds
- Apply continuous pressure for at least 10 minutes to the fleshy front part of the nose by pinching it between the index finger and thumb. Keep the child sitting up and leaning forward, breathing through their mouth. It may be easier to place younger children on your knee facing outwards. Encourage them not to swallow the blood but instead to spit it out, as swallowing blood can cause them to vomit which can then trigger the nose bleeding to restart.
- Keep talking to your child with reassurance and keep them as calm as possible. It is tempting to release the pressure from the nose to check if the bleeding has stopped, but do not do so until the 10 minutes have finished, as this could prevent a clot from forming. If there is an ice pack available, this can be placed on their forehead or on the nape of their neck.
- Giving them a cool drink can also help them cool down.
- If there is ongoing bleeding after 10 minutes, recheck that the position of the pressure being applied is correct and apply pressure for a further 10 minutes.
- If at this point, there is ongoing bleeding then you should immediately attend your nearest Accident & Emergency department or call an ambulance and calmly continue applying first aid measures until they arrive.
- First aid advice from the British Red Cross on how to stop a nosebleed in a child.
After a nosebleed
If the bleeding has stopped by the first aid measures you have applied, then for the next 24 hours your child should be advised:
- Not to pick or blow their nose
- To undertake restful and quiet activities (such as reading or drawing)
- To avoid hot baths, showers, and warm drinks
To prevent future nose bleeds:
If your child’s nose is dry and cracked, apply petroleum-based jelly (e.g. Vaseline) to the nostrils, generally twice each day for a week. This can be done by using a cotton tip or finger, and gently rubbing it on the inside of the nose. Do not use this method in children under four years of age as they are unlikely to cooperate or sit still, and their nose may be injured. If your child is suffering from constipation, increase their fluid intake and the amount of fibre in their diet, or ask your doctor or pharmacist for a stool softener to prevent them from straining.
Where should you seek help?
- If it is non-urgent, speak to your local pharmacist or health visitor.
- Or contact you GP practice and a qualified member of the clinical team will assess if your child needs to be seen urgently. For an urgent out-of-hours GP appointment, call NHS 111.
- You should only call 999 or go your nearest A&E department in critical or life threatening situations.