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



Estimated Reading Time 2 Minutes

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.

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