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Wednesday, June 19, 2019

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Nosebleed among children

Nosebleed or epistaxis is a condition when the membranes inside the nose are irritated or injured and start to bleed. It occurs commonly among children, especially among those between the ages of 2 and 10. Thirty percent of children have one nosebleed by the time they are five years old. Epistaxis is rare in infancy and infrequent after puberty. It occurs much more frequently in the late fall and winter when the upper respiratory tract infections are common, environmental humidity is relatively low and the use of heating system results in dryness.

Types of nosebleeds
Nosebleed may be either anterior or posterior . With anterior nosebleed, blood exits almost entirely from the anterior portion of the nose. With posterior nosebleeds, most of the bleeding occurs in the nasopharynx and mouth, although some blood exits through the nose as well. Posterior nosebleeds are heavier and difficult to control.The large majority of nosebleeds among children (90%) are anterior and easily controlled.

 

Causes of nosebleed
There are many causes of nosebleed but most commonly, among children, the bleeding is from trauma or inflammation. The trauma can be from sneezing, repeatedly picking the nose or even a bump. Inflammation is generally from a cold or allergy or even medicines used to treat these conditions. However, few children may have bleeding disorders that show through recurrent nosebleeds. Rarely, a tumor in the nose can cause recurrent bleeding from only one side . Not to be forgotten is the nosebleed from a foreign body inserted in the nose that causes trauma or inflammation.


Management of nosebleed

First aid

If the nose of your child is actively bleeding, it is advisable to take the following measures:

•  Keeping the child in a sitting position is best. Make him lean forward with his head slightly tilted down. If your child is hurt and needs to lie down, prop his head up on pillows.

Leaning backward is a wrong practice, since this will allow the blood to drain into the belly and cause some children to vomit the blood later.

•  If your child has blood in the mouth, he should spit it out.

•  Apply pressure to the nose by squeezing the nostrils together. Hold for 10 minutes. Do not peek to check if the bleeding has stopped. You will need to start over if you do.

•  If the bleeding does not stop, press an ice bag or a towel soaked in cold water on the ridge of the nose.

•  Do not stick tissues, gauze or other things into the nose.

•  Have your child avoid rough activities where the nose could be bumped.

•  Release a sneeze through the mouth instead of the nose. Blow the nose gently if needed.

Medical treatment
If the above-mentioned measures fail, contact your doctor to initiate the medical treatment. The latter may involve the following:

  • Nasal decongestants, that cause blood vessels to constrict, minimizing the bleeding
  • Special nasal packs that consist of a sterile material soaked in a solution that constricts the blood vessels. The pack may be placed by an ENT (Ear, Nose and Throat specialist) or an emergency medicine physician. The nose might be packed for few days.
  • Further treatment may involve a procedure called cauterization. This entails minor surgery to identify the bleeding site and burn it by applying heat, thus coagulating the nasal tissues to induce healing.

A nosebleed that is not contolled within 10 to 15 minutes should make you consider seeking aid for your child. Recurrent nosebleeds (2-4 in a two week period are common) over several weeks would be alarming. They are generally the sign of a sinus infection or problems that are more serious.

Prevention of nosebleed
If due to dry nasal tissues, nose bleeding can sometimes be prevented by:

•  Placing a moisturizing cream (KY jelly or Vaseline) into the nose with a Q tip. This should be done two to four times a day.

•  Placing a humidifier at home; however, this would promote molds and other allergens.

•  Discouraging the child from picking the nose

•  Using normal saline drops to keep the noise moist. Normal saline will keep blood from crusting.

While nose bleeding among children is most of the time a result of nasal drying, as discussed in the above article, it is not the case in adults. Epistaxis among adults might be a warning sign of high blood pressure or a bleeding problem. Thus, any nasal bleeding among adults that persists, recurs, or is severe needs to be evaluated by a doctor.