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Nose bleeds

Nose bleeds are a common childhood problem. Children usually grow out of nose bleeds by age 11.  Normally they don't last long and can be managed at home.

Causes of nose bleeds include:

  • a minor injury for example a bump to the nose
  • nose picking
  • coughs and colds
  • allergic rhinitis (hay fever)
  • foreign body (something stuck up the nose)
  • 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 nose bleed requires further help or whether it can be managed by yourself at home.

If your child has any of the following:

  • If your child is on medication that prevents blood clotting (such as warfarin, heparin or aspirin)
  • If your child is less than 2 years old
  • If the nose bleed has been ongoing for more than 30 minutes despite appropriate first aid
  • If the nose bleed is from both nostrils (this suggests a nose bleed 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 nose bleed from the back of the nasal passageway)
  • If your child has significant disfigurement to their nose after injury to the face

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

(first aid should be started simultaneously – see below)

If your child has any of the following:

  • If there is a discharge from the nose alongside the nose bleed (as this may be due to a foreign body in the nose)
  • If your child has frequent small volume nose bleeds 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 need to contact a doctor or nurse today

Please call your GP surgery or contact NHS 111 - Go to 111.nhs.uk or call 111.(111 online does not currently take questions about children aged under 5, so if your child is 4 or younger,  please call 111).

If symptoms persist for 4 hours or more and you have not been able to speak to either a member of staff from your GP practice or to NHS 111 staff, recheck that your child has not developed any red features.

(first aid should be started simultaneously – see below)

If none of the above features are present

Care using the advice below, can be provided to your child at home if none of the above features are present. If your child continues to get frequent nose bleeds, please arrange to speak to your GP or practice nurse.

Self care

Continue providing your child’s care at home. If you are still concerned about your child, speak to your health visitor, local pharmacist or call NHS 111– dial 111

First aid for nose bleeds:

Apply continuous pressure for 20 minutes to the fleshy front part of the nose by pinching it between index finger and thumb. Keep the child sitting up and leaning forward, breathing through their mouth (see diagram below). 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 20 minutes has finished. If there is ice available, then your child can also suck on some ice during this time or an ice-pack 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 – 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 call an ambulance and calmly continue applying first aid measures until they arrive.

nosebleed graphic.jpg

After the nose bleed:

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 a 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.

Where should you seek help?

For wear and tear, minor trips and everything in between.

Self-care

You can treat your child's very minor illnesses and injuries at home.

Some illnesses can be treated in your own home with support and advice from the services listed when required, using the recommended medicines and getting plenty of rest.

Sound advice

Children can recover from illness quickly but also can become more poorly quickly; it is important to seek further advice if a child's condition gets worse.

For information on common childhood illnesses go to What is wrong with my child?

Pharmacists are experts in many aspects of healthcare and can offer advice on a wide range of long-term conditions and common illnesses such as coughs, colds and stomach upsets. You don’t need an appointment and many have private consultation areas, so they are a good first port of call. Your pharmacist will say if you need further medical attention.

Sound advice

  • Visit a pharmacy if your child is ill, but does not need to see a GP
  • Remember that if your child's condition gets worse, you should seek further medical advice immediately
  • Help your child to understand - watch this video with them about going to the pharmacy

For information on common childhood illnesses go to What is wrong with my child?

Health visitors are nurses or midwives who are passionate about promoting healthy lifestyles and preventing illness through the delivery of the Healthy Child Programme. They work with you through your pregnancy up until your child is ready to start school.

Health Visitors can also make referrals for you to other health professionals for example hearing or vision concerns or to the Community Paediatricians or to the child and adolescent mental health services.

Contact them by phoning your Health Visitor Team or local Children’s Centre.

Sound advice

Health visitors also provide advice, support and guidance in caring for your child, including:

  • Breastfeeding, weaning and healthy eating
  • Exercise, hygiene and safety
  • Your child’s growth and development
  • Emotional health and wellbeing, including postnatal depression
  • Safety in the home
  • Stopping smoking
  • Contraception and sexual health
  • Sleep and behaviour management (including temper tantrums!)
  • Toilet training
  • Minor illnesses

For more information watch the video: What does a health visitor do?

School nurses care for children and young people, aged 5-19, and their families, to ensure their health needs are supported within their school and community. They work closely with education staff and other agencies to support parents, carers and the children and young people, with physical and or emotional health needs.

Contacting the School Nurse

Primary and secondary schools have an allocated school nurse – telephone your child’s school to ask for the contact details of your named school nurse.

There is also a specialist nurse who works with families who choose to educate their children at home.

Sound Advice

Before your child starts school your health visitor will meet with the school nursing team to transfer their care to the school nursing service. The school nursing team consists of a school nursing lead, specialist public health practitioners and school health staff nurses.

They all have a role in preventing disease and promoting health and wellbeing, by:

  • encouraging healthier lifestyles
  • offering immunisations
  • giving information, advice and support to children, young people and their families
  • supporting children with complex health needs

Each member of the team has links with many other professionals who also work with children including community paediatricians, child and adolescent mental health teams, health visitors and speech and language therapists. The school health nursing service also forms part of the multi-agency services for children, young people and families where there are child protection or safeguarding issues.

GPs assess, treat and manage a whole range of health problems. They also provide health education, give vaccinations and carry out simple surgical procedures. Your GP will arrange a referral to a hospital specialist should you need it.

Sound advice

You have a choice of service:

  • Doctors or GPs can treat many illnesses that do not warrant a visit to A&E
  • Help your child to understand – watch this video with them about visiting the GP or going to a walk in centre

For information on common childhood illnesses go to What is wrong with my child?

If you’re not sure which NHS service you need, you can call 111 or use 111 online.

Please note that 111 online is for people aged 5 and over. Call 111 if you need help for a child under 5.

An adviser will ask you questions to assess your symptoms and then give you the advice you need, or direct you straightaway to the best service for you in your area.

Sound advice

Use NHS 111 if you are unsure what to do next, have any questions about a condition or treatment or require information about local health services

For information on common childhood illnesses go to What is wrong with my child?

A&E departments provide vital care for life-threatening emergencies, such as loss of consciousness, suspected heart attacks, breathing difficulties, or severe bleeding that cannot be stopped. If you’re not sure it’s an emergency, call 111 for advice.

Sound advice

  • Many visits to A&E and calls to 999 could be resolved by any other NHS services
  • If your child's condition is not critical, choose another service to get them the best possible treatment
  • Help your child to understand – watch this video with them about going to A&E or riding in an ambulance
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