Causes Of Nosebleed In Toddlers, Its Treatment And Prevention

Finding blood dripping from your toddler’s nose without any apparent injury can cause you to worry. Nosebleed in toddlers is a common occurrence but is usually present for a short time.

However, recurrent episodes may be a cause for concern. In such cases, it is crucial to diagnose the underlying health issue. Read this post to know about the various causes, home-care measures, treatment, and prevention of nosebleeds.

What Is Nosebleed?

Nosebleed, also called epistaxis, is a result of ruptured blood vessels within the nasal mucosal lining. There are two types of nosebleeds (1):

1. Anterior nosebleed: In this common type of nosebleed, the blood capillaries at the anterior end, at the front side of the nasal lining, rupture and the blood flows out through the nostrils.

2. Posterior nosebleed: The bleeding happens deep within the nose in the tissues that lie at the posterior end of the nose. In this case, most of the blood trickles down into the throat from where it may reach the mouth as well.

The anterior nosebleed is what you predominantly notice among toddlers.

What Causes Nosebleeds In Toddlers?

The causes are aplenty ranging from benign conditions to severe health problems (2).

1. Nose injury: A direct impact or trauma to the nose can cause the blood vessels in the nose to rupture, resulting in a nosebleed. Toddlers tend to be quite active and may run around a lot. With that comes the risk of stumbling upon something or being hit by an object, resulting in a nosebleed.

2. Picking nose: It is often the common cause of frequent nosebleeds in a toddler. Fingernails can scrape the delicate nasal wall, leading to bleeding.

3. Blowing the nose too hard: If your toddler attempts to blow his nose too hard, it may cause a blood vessel in the nose to rupture leading to streaking of nasal discharge with blood.

4. Forceful coughing: Some diseases such as cystic fibrosis can cause the toddler to cough repeatedly with excessive force. It increases the pressure within blood vessels inside the nose, leading to their rupture followed by bleeding (3).

5. Dry air: It can dry the nose from inside so much that the walls of blood vessels tear causing the blood to leak out. Dry, ambient air is particularly common during winter and the heaters further dry the air. Excessive heat also dries the air, thus toddlers could have nosebleeds even during summer.

6. Smoke or toxic fumes: Toxic elements in the air or smoke from vehicular effluents and tobacco burning can irritate the nose of a toddler, resulting in bleeding.

7. Infections: Several upper respiratory infections can lead to a toddler’s nosebleed. The most common ones are common cold and sinus infections. Both these conditions inflame the nasal lining to the extent that the blood vessels swell, rupture, and bleed. Such infections can cause other symptoms such as a headache before a nosebleed.

8. Allergies: Substances such as pollen, dust, and fur particles can cause sudden nosebleed in toddlers. A common allergy that causes nasal inflammation and nosebleeds in toddlers is allergic rhinitis. Allergies may cause chronic nose bleeding since allergens such as pollen and dust particles are too small to be visible and can be taken in unknowingly.

9. Nasal tumors: They are rare, but can happen and result in nose bleeding. The most common tumor is the juvenile nasopharyngeal angiofibroma. Nasal tumors are mostly localized, benign, and very rare in occurrence; moreover, they display other symptoms along with nose bleeding (4).

10. Foreign body inside nose: Toddlers tend to stick small objects into their nostrils. A foreign body can injure or infect the delicate inner nasal lining, both of which can cause nosebleeding in toddlers.

11. Blood diseases: Several blood diseases increase the risk of nosebleeding in toddlers. One example is hemophilia where the blood does not clot quickly. Another condition is leukemia, the cancer of the leukocytes (a type of white blood cell), where the blood platelet levels drop causing poor blood clotting (5).

12. Aplastic anemia: In this type of, the bone marrow is unable to produce adequate red blood cells, white blood cells, and platelets. Aplastic anemia can increase the risk of nose bleeding due to inadequate availability of platelets that help clot the blood (6).

13. Head injury: Most head injuries in toddlerhood seldom result in internal bleeding. However, a nasty fall from a height or even from the stairs can lead to bleeding within the brain. Since there is no room inside the skull for the blood to move out, it eventually flows out of the nostril (7).

14. Injury to the face: Damage to the bones and blood vessels around the nose can also cause bleeding through the nose. An example is an injury to the bones and tissue around the eyes that often leads to a black eye, which is medically called periorbital hematoma/hemorrhage. The blood from the ruptured blood vessels dribbles into the nose leading to nosebleeding (8).

15. Side effects of medicines: Sometimes nosebleeding may occur as a side effect of medication such as ibuprofen. However, in such cases, the toddler will have nosebleeding along with other side effects such as vomiting and diarrhea.

Nosebleeding is itself a symptom, but sometimes the condition may go unnoticed thus making it vital to know its signs.

What Are The Signs Of Nosebleeding In A Toddler?

Blood dripping from the nose indicates nosebleed, but there are other subtle signs of nosebleeding in a toddler.

• Clotted blood in the nose: You may notice solidified clotted blood around the nostril, or the toddler may often pick out small pieces of clotted blood from the nose.

• Redness around the nostril rims: The edge of the nostrils has a reddish tint, which could indicate a minor nosebleed.

• Blood on the toddler’s bedding: The cold temperature and dry air during the night may aggravate a toddler’s cold. It may cause spontaneous nosebleeding during the night that can be evident from the stains of blood on the toddler’s bedding.

• Blood spots in mucus: When your toddler sneezes or when you wipe his nose you notice tiny spots of blood in the nasal mucus.

• Blood in vomiting: In case of posterior nosebleed, most of the blood flows into the throat from where it trickles into the stomach. An acute nosebleed may cause a lot of blood to flow into the stomach and trigger vomiting. When the toddler vomits, you may observe blood in it. However, blood in the vomit can occur due to several reasons, and not just nosebleed.

Once you spot the nose bleeding, it is essential to control it right away.

How To Control Nose Bleeding In Toddlers?

Pediatric experts recommend the following steps of first aid to control the toddler’s nosebleed (9):

1. Get the toddler in a sitting position like on a chair with his head tilted forward. Do not make him lie down or tilt his head backward as it can cause the blood to flow into the throat, leading to a cough.

2. Ask the toddler to stay quiet. Talking, screaming, or crying may cause the nosebleed to aggravate. Therefore, ask him to close his mouth tightly and remain calm.

3. Gently pinch and close the nostrils for five minutes. You can ask the toddler to breathe through the mouth during this time. Remove your hold from the nostrils after five minutes. If the bleeding has not stopped yet, then pinch the nostrils for five more minutes.

4. After you are done pinching the nose, take a tissue paper or a cotton ball and gently rub it around the nostril to absorb the remainder of the blood. Do not stuff the nose or put the tissue paper/cotton ball deep into the nose. Also, do not scrape any clotted blood around the nostrils.

Nosebleeds are often a harmless childhood condition, but in some scenarios, you have to be extra careful.

When To Rush To A Doctor?

Rush your toddler to a doctor in the following situations (10):

• Nosebleed does not stop within 20 minutes.

• Toddler seems to get drowsy after a nosebleed.

• Loss of consciousness after a nosebleed.

• Nosebleed is due to severe injury or some foreign object inserted into the nose.

• Toddler turns pale during a nosebleed.

• Blood is flowing from the mouth too.

• Toddler has a fever every time after a nosebleed.

The doctor will observe the other symptoms and do some tests to diagnose the underlying condition.

How Are Reasons Behind Nosebleed Diagnosed?

Since there can be several reasons behind a nosebleed, the doctor uses the following steps to diagnose the underlying cause behind the nosebleed:

1. Toddler’s medical history: You would have to answer questions on any past infections or conditions that the toddler had suffered, and about the area where you live and its surroundings as dry climate exasperates nosebleeds.

2. Physical examination: An endoscope is inserted into the toddler’s nose to inspect the nasal lining for any defects or the presence of a foreign body.

4. CT scan: This is composed of several X-rays and gives an extensive imagery of the nose and the surrounding tissue. The scan helps diagnose the presence of any nasal defects and the extent of any injury.
5. Blood test: The test detects pathogens that could cause diseases such as common cold and flu. Allergies and presence of blood disease are also determinable through a blood test.
   Once the cause is diagnosed, the doctor suggests the treatment options.

How Is Nosebleed In Toddlers Treated?

The cure is entirely dependent on the fundamental cause of nosebleeds. The following are the steps for treatment of nosebleeds in toddlers (11):

1. Nasal packing: It is the insertion of sterile absorbable gauze (bandage-like strips) inside the nose. It creates pressure on the site of bleeding and absorbs excess blood thus helping the remainder of the blood to clot faster. Thin adhesive strips may be stuck to the bridge of the nose to prevent pressure build-up in the blood vessels. These procedures work by altering the pressure in the nasal blood vessels to make them less prone to tearing (12).

2. Antibiotic treatment: If the nosebleed is the result of a nasal infection, then it would be treated with the use of antibiotics. Viral infections such as a common cold can also cause nosebleeds, but cannot be treated with antibiotics. In such cases, the doctor suggests the necessary steps for speedy recovery.

3. Foreign body removal or repair of injury: If nosebleed is due to an object stuck in the nose, then it is promptly removed. If the cause is face, nose, or head injury, then the damage is repaired through surgical intervention and therapeutic treatment.

4. Nasal cauterization: It is only used when the toddler has severe recurrent nosebleeds. In nasal cauterization, the doctor first identifies the blood vessels that rupture chronically. The walls of these blood vessels are then permanently sealed using a chemical agent such as silver nitrate. Alternatively, the blood vessels could be destroyed by passing a mild current (13).

The procedures of nasal packing and cauterization may seem invasive but provide permanent relief from recurrent nosebleeds in a toddler. Treatment through such methods is usually necessary when nose bleeding becomes a severe issue. Even as the treatment continues, you need to observe precaution.

How To Care For The Toddler At Home After A Nosebleed?

Ensure optimum care for your little one at home through the following steps (14):

1. Get maximum rest for 24 hours: Focus on rest and cut down on high-intensity activities such as outdoor play and running. Instead, let your toddler play with his toys indoors, spend time reading storybooks, or color. Resting helps normalize the blood pressure that can give time for the blood vessels in the nose to heal.

2. Avoid hot food, drinks, and hot bath: For the next 24 hours, do not serve hot beverages and food to your toddler. Also, avoid hot baths. Heat may trigger a nosebleed again and slow down the healing process.

3. No nose-picking and blowing: Tell your toddler not to pick or blow his nose for a day. Help him clean his nose.

There are over-the-counter nasal lubricating ointments available, but you must avoid using them if you haven’t consulted a pediatrician.

Once the nosebleeding stops, you may take some precautions to make sure that it doesn’t recur.

How To Prevent Nosebleeds In A Toddler?

Here are a few things you can do:

1. Use saline drops: Your pediatrician will most likely recommend saline drops for chronic nosebleeds. Specialized saline drops are administered usually before bedtime to moisten the nasal cavity. It helps keep the mucosal lining moist and prevents abnormal rupture of blood vessels.

2. Humidifier: Most pediatric experts recommend the use of a cool-mist humidifier in your toddler’s room (15). It is particularly useful when the nosebleed is the result of cold and cough. Humidifiers add water vapor to the ambient air thus making it less harsh for the nasal lining. Remember only to use cool-mist humidifiers (also called vaporizer) and not hot-mist/steam humidifiers that increase the risk of minor scalding and even severe burns.

3. Use petroleum jelly: Gently apply petroleum jelly, sold as Vaseline, within the toddler’s nostrils once in a day throughout the dry season or whenever the toddler displays chronic nosebleeds. Apply petroleum jelly a few millimeters within the nostril but do not insert your finger too deep. This remedy is particularly useful with anterior nosebleeds.

4. Trimming the toddler’s nails: Sometimes, nosebleeds are just a result of your toddler’s nose-picking. Clip his nails to mitigate its chances.

6. Staying alert for infections and allergies: If your toddler has an allergy, then make sure you prevent exposure to the potential allergen. In case of infections, such as cold, take your preschooler to a doctor right away to prevent nosebleeds.

7. Preventing injuries: At home, take preventive measures such as gating the staircase and tucking away loose wires to prevent falls. When outdoors, keep a watch on the toddler and guide him on safe ways of playing.

References

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Rohit Garoo

 

Rohit Garoo is a writer-turned-editor with over 9 years of experience in content writing, editing, and content marketing. He did his bachelors in Science at St. Xavier's College, Hyderabad, and masters in Business Administration at Osmania University.

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