Nosebleeds in Children – Causes, Treatment, Complications and Types

Nosebleeds Definition

When one or two of the small veins in the nose erupt, the resulting condition is nosebleed or epistaxis. Nosebleeds can be caused by a myriad of events; it could be due to trauma as a result from picking the nose, temperature changes or a symptom of another disease. Nosebleeds can also be harmless or it could be a predictor of a serious disease.

Nosebleeds in children is a common case, in fact; almost 30% of children from 0 to 5 years old have episodes of nosebleeds, 56% for 6 to 10 year old children, and 64% of 11 to 15 year old children.

Most cases of nosebleeds are dealt with simple treatment or management; however we still cannot discount the fact that this could be a sign of an underlying condition. To better help us determine what conditions prompt medical attention, we must first know more about nosebleeds in children.

 

Types (Terminology)

Recurrent Nosebleeds

In recurrent nosebleeds the episode of bleeding happens only at certain periods of time. The bleeding may happen today, and then happen again after a week or so. Recurrent nosebleeds can be due to seasonal patterns, this can be observed in most cases where the bleeding episode only happens when the weather gets hot and dry, and ceases when during the cold months. Medical attention must be done if the recurrent nosebleed presents the following:

1. Nosebleeds that recurs frequently
2. Does not assume a seasonal pattern,
3. When other symptoms such as bleeding of the gums and easy bruising is noted.

These conditions can signify the child has a bleeding problem and that the nosebleeds might be a symptom of an underlying disease.

Constant Nosebleeds

This is the type of nosebleed that happens for a longer period of time. Oftentimes nosebleeds happen as a single incidence, but in constant nosebleed, the bleeding is continuously. The bleeding may last to up to 45 minutes (common nosebleeds only occur within 15 minutes).Constant epistaxis is always a sign of alarm, especially if the bleeding is heavy.

Sudden or spontaneous Nosebleeds

These are nosebleeds which could happen anytime of the day, regardless of the activity of the child, whether the child is resting or playing. This is the most common type of bleeding episode, where the child suddenly experiences bleeding from the nose.

Chronic Nosebleeds

Chronic conditions are defined as conditions that are continually experienced for more than six months. Nosebleeds are considered chronic if the child continuously experiences the same condition for more than six months. Chronic nosebleeds happen as result of a chronic underlying disease, these include:

• Chronic liver or kidney disease
• Blood dyscratias
• Long term use of medications that cause bleeding
• Vascular malformations

Children with this type of bleeding episode has to deal with the nosebleeds for life, treatment for this usually focus on the underlying disease condition.

Heavy Nosebleeds

Heavy nosebleeds pertain to episodes where there is a significant amount of blood coming out of the nose. Heavy nosebleeds describe bleeding that is severe, profuse and continuous. Once this type is seen, immediate first aid treatment must be employed and the child must be rushed to a nearest medical facility for evaluation.

What Causes Nosebleeds in Children?

• Trauma – from picking or inserting a foreign object to the nose. Such activity can cause the small sensitive blood vessels in the nose to burst.
• Sudden temperature changes- this event causes blood vessels to constrict and dilate. The sudden constriction and dilation can put a significant stress on the blood vessel; this then causes some of them to rupture.
• Problems in blood clotting– conditions in which the body lacks the ability to initiate blood clotting, this makes the child prone to nose bleeds. Vitamin K deficiency is one of the causes of blood clotting problems. Vitamin K helps in the process of clot formation, without it blood cannot clot properly.
• Infections – infectious agents such as viruses and bacteria release certain chemicals that can destroy the blood and blood vessels. This then cause bleeding tendencies (such as in the case of dengue fever).
• Valsalva maneuver or excessive straining-excessive pressure from straining causes blood vessels to rupture. In children this happens when they are constipated.
• Medications– certain medications can cause changes in the blood and their normal behavior. Aspirin for example, is a drug that has an anticoagulant effect. This means it prevents the blood from coagulating; this makes the blood free flowing and unable to clot or aggregate in cases of trauma, stress or temperature changes.
• Blood disorders– nose bleeds can also be caused by certain disease conditions. Anemia, Von Willebrand’s disease, and Osler-Weber-Rendu syndrome are just some blood disorders that cause nosebleeds in children.

Associated Symptoms of Nosebleeds

In some cases, nosebleeds in children are accompanied by other associated symptoms. Other symptoms are very helpful in knowing the true condition of the child. It helps the clinician determine if the nosebleed is a part of a myriad of symptoms that suggest a disease. Significant associated symptoms of nosebleeds are as follows:

• Gum Bleeding
• Bruising especially in the upper extremities
• Facial swelling or pain
• Nasal blockage or presence of nasal discharges
• Pain in the head or neck
• Presence of allergies

Diagnosis of Nosebleeds

Diagnosis that evaluates the source of the bleeding is done by determining the following:

1. Presence of crusting on the nasal septum- this usually indicates infection and inflammation
2. Presence of Visible blood vessels present on the anterior septum- this is observed in almost 50% of the cases, and it was also observed that bleeding occurs on the side where the vessels are visible.
3. Presence of pyogenic granulomas and tumors

To rule out other underlying conditions that may cause the bleeding episode, the following are done:

• Complete blood count – This determines deficiencies such as anemia or lack of platelets responsible for clotting.
• Coagulation studies – This determines if the child has normal blood clotting.
• MRI – To view the inner structures of the nose
• Angiography – To view the structure of the blood vessels and if there are obstructions
• Endoscopy and biopsy – To determine if there are tumors or other abnormal growths

Treatment of Nosebleeds

• Employ first aid measures– during episodes of nosebleeds, whether that is mild or severe case, first aid measures must be done initially until medical help is available
• Let the child sit, with upper body tilted forward
• Keep his/her mouth open to prevent the child from swallowing the blood
• Pinch the upper part of the nostrils just below the bony prominence (or the fleshy part of the nose) with the thumb and index finger
• Apply an icepack to the nose and cheek area

Continue the procedure until the bleeding stops, when the bleeding does not stop, the child must be sent to the nearest medical facility. Severe bleeding episodes can be treated with the following interventions:

• Intravenous fluid therapy to prevent blood loss
• Silver nitrate cautery if visible vessels are found
• Naseptin antiseptic cream if infection is present
• Hemostatic agent such as Kaltostat
• Possible surgery in the case of tumors

Complications

The primary complication of untreated nosebleeds is severe bleeding and shock. This is not directly due to the loss of blood from the nose. Since nosebleeds can be a sign of a bleeding disorder, disregarding them could lead to the worsening of the underlying condition. The child might go undiagnosed or untreated if the episode of epistaxis is taken for granted. That is why it is important to know when the child’s nosebleed needs medical attention.