Clinical Reference Systems: Pediatric Advisor 10.0

DESCRIPTION

Nosebleeds (epistaxis) are very common. They are usually caused by dryness of the nasal lining plus the normal rubbing and picking that most people do when the nose becomes blocked or itchy. Vigorous nose blowing can also cause bleeding. People who have nasal allergies are more likely to have nosebleeds because they rub and blow their noses more.

HOME CARE

1. Stopping the bleeding
   • Lean forward and spit out any blood. Sit up and lean forward so you don't have to swallow the blood. Have a basin available so you can spit out any blood that drains into your throat. Swallowed blood is irritating to the stomach and can cause nausea or vomiting.
   • Apply pressure by squeezing the soft part of the nose. First blow your nose to free any large clots that might interfere with applying pressure. Then tightly pinch the soft parts of the nose against the center wall for 10 minutes. Don't release the pressure until 10 minutes are up. If the bleeding continues, you may not be pressing on the right spot. During this time, you will have to breathe through your mouth.
   • If bleeding continues, use vasoconstrictor nosedrops and squeeze again. If the nosebleed hasn't stopped, insert a gauze covered with vasoconstrictor nosedrops (for example, Neo-Synephrine) or petroleum jelly into the nostril. Squeeze again for 10 minutes. Leave the gauze in for another 10 minutes before you remove it. If bleeding persists, call your physician but continue the pressure in the meantime.

2. Prevention
   • A small amount of petroleum jelly applied twice a day to the center wall inside the nose (the septum) often helps relieve dryness and irritation.
   • Increasing the humidity in your room at night by using a humidifier may also be helpful.
   • Get into the habit of putting two or three drops of warm water in each nostril before blowing a stuffy nose.
   • Avoid aspirin. One aspirin can increase the tendency of the body to bleed easily for up to a week and can make nosebleeds last much longer.
   • If you have nasal allergies, treating allergic symptoms with antihistamines will help break the itching-bleeding cycle.

3. Common mistakes in treating nosebleed
   • A cold washcloth applied to the forehead, bridge of the nose, back of the neck, or under the upper lip does not help stop nosebleeds.
   • Pressing on the bony part of the nose does not help stop nosebleeds.
   • Try to avoid packing the nose with anything because when it is removed, the nose usually starts bleeding again.

CALL YOUR PHYSICIAN IMMEDIATELY IF:

• The bleeding does not stop after 20 minutes of direct pressure on the nose.

CALL YOUR PHYSICIAN DURING OFFICE HOURS IF:

• Nosebleeds are a frequent problem even after petroleum jelly and humidification are used.
• You have other concerns or questions.