Ask Dr. Marla: How do I treat a toddler's nosebleed?

By Dr. Marla Shapiro on April 19, 2013
My 18-month-old has a perpetually runny nose that often looks tainted with blood. Does it mean he might get a nosebleed? I get nosebleeds sometimes and I’m wondering what to do if my toddler gets one.

Answer:

Runny nose is very common in this age group and often is worse during the winter or flu season. In the winter, nasal linings are often dryer. Many other factors contribute to nosebleeds such as allergies and having smokers in the home. In the front of the nasal septum is an area called Little’s area and this area is rich in blood vessels. About 90 percent of all nosebleeds occur in this area and that is likely because it is exposed to the drying effect of the air we breathe. If there is a lot of inflammation in the nasal area it is not uncommon to occasionally see a blood-tinged discharge. This area is also readily in reach of a child’s probing finger!

Fortunately, most of the numerous possible causes for nosebleeds are not worrisome. Nosebleeds are rarely a sign of a serious problem such as a tumor or a bleeding disorder.

Bleeding on just one side of the nose is more likely to result from local trauma, like nosepicking, or the possibility of a small foreign object like a plastic toy stuck in the nose. If bleeding patterns are getting worse and more frequent over time, that would require investigation.

If the nosebleeds have associated symptoms, these might serve as red flags that there is something underlying. For example, a sinus infection with facial pain might be the cause. In children who have a headache and nosebleed, it merits measuring blood pressure, although this is less common in children than adults. Bleeding that goes on for more than 20 minutes requires medical attention.

You mentioned that you have frequent nosebleeds as well. This does not necessarily mean your children will have nosebleeds. However, if you have a history of recurrent severe nosebleeds it could point to a hereditary condition called hemorrhagic telangiectasia. In this condition, common signs include splinter hemorrhage in the nail beds as well as small vascular papules inside the nose and around lips and tongue. This is less likely. And finally, a strong family history of nosebleeds causes suspicion for a mild bleeding disorder such as Von Willibrand’s disease, which is an inherited genetic disorder.

How to treat a nosebleed

Toronto’s SickKids Hospital offers this advice:
  • Stay calm.
  • Have your child sit tall.
  • Tilt your child’s head forward.
  • Gently squeeze the soft portion of your child’s nose with your thumb and index finger. Hold for 10 to 15 minutes (without stopping).
  • Once the bleeding has stopped, encourage quiet, non-boisterous play. Tell your child not to blow, pick, rub, or sniff his nose for the next few hours.

Got a health question? Submit it to Dr. Marla.

Originally published in ParentsCanada magaine, May/June 2013.

By Dr. Marla Shapiro| April 19, 2013

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