Dr. Ameen, ENT Specialist in Kuala Lumpur

Epistaxis, the medical term for a nosebleed, is a common and often frightening experience for children and their caregivers. While most episodes are benign, understanding the causes and proper, evidence-based treatment is crucial for quick resolution and peace of mind.

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What Causes Nosebleeds in Children?
The majority of nosebleeds in children originate from the Kiesselbach’s Plexus (also known as Little’s Area), a network of fragile blood vessels located on the anterior (front) part of the nasal septum. Bleeding from this area is typically anterior and less severe.

Renowned medical journals and studies identify several key factors:
1) Digital Manipulation (Nose Picking): This is overwhelmingly cited as the most frequent cause across various pediatric studies in publications like the Rhinology Journal and International Journal of Pediatric Otorhinolaryngology.

2) Dry Nasal Mucosa: Low humidity, often from heated indoor air, causes the delicate nasal lining to dry out and crack, making the underlying blood vessels more vulnerable to rupture.

3) Trauma: Minor trauma, such as rubbing the nose, vigorous sneezing, or accidental knocks, can trigger bleeding.

4) Inflammatory Diseases/Infections: Upper respiratory tract infections (URTIs), sinusitis, and allergic rhinitis can cause congestion and inflammation, leading to friable (easily damaged) nasal mucosa. One study noted that inflammatory diseases were the most common cause in 50.5% of pediatric cases.

5) Systemic Factors (Less Common): In cases of recurrent, severe, or difficult-to-stop bleeding, less common causes like bleeding disorders (e.g., von Willebrand disease, hemophilia) or certain medications (like NSAIDs or topical nasal steroids) should be considered, as noted in StatPearls.

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Evidence-Based Treatment: The First-Aid Approach
For the vast majority of anterior nosebleeds, simple first aid is highly effective, as confirmed by numerous clinical guidelines.

1) Stay Calm and Sit Up: Keep the child calm and have them sit upright.

2) Lean Forward: Instruct the child to lean slightly forward, not backward. Leaning forward prevents blood from draining down the throat, which can cause gagging or vomiting.

3) Apply Pressure: Pinch the soft, fleshy part of the nose (below the bony bridge) continuously for 10 to 15 minutes. It is essential to maintain constant pressure for the full duration without peaking.

4) Breathe Through the Mouth: Encourage the child to breathe through their mouth and spit out any blood that drains into the throat.
If the bleeding does not stop after two attempts of 10-15 minutes of continuous pressure, medical attention is required.

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Preventing Recurrence
To prevent future episodes, particularly those caused by dry mucosa and digital trauma, medical reviews recommend:

1) Nasal Moisturization: Regular application of a simple moisturizing agent (like petroleum jelly or a specific nasal emollient) to the inside of the nostrils, especially the anterior septum, helps heal the vulnerable mucosa.

2) Humidification: Using a cool-mist humidifier, especially in the child’s bedroom during dry seasons or low-humidity conditions.

3) Addressing Underlying Issues: Treating allergies, infections, or excessive nasal crusting with saline sprays or prescribed topical antibiotics can reduce mucosal irritation.

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