Should I Worry About My Child’s Bloody Nose?

Nosebleeds in children are common. They happen when the thin tissue that lines the nose — the mucous membrane — becomes irritated. Irritation may cause tiny, delicate blood vessels in the nose to begin bleeding.

Kids of all ages can get nosebleeds, although they’re less common in children under 2, says Kathleen R. Billings, MD, FACS, FAAP, attending physician in otorhinolaryngology-head and neck surgery at Lurie Children’s. Here’s when to worry about a nosebleed and what you can do to help prevent nosebleeds in your child. 

What causes nosebleeds in kids?

Your body makes mucus constantly. This clear, slippery liquid helps trap bacteria and germs that enter your nose. Nosebleeds in kids usually have a lot to do with mucus crusting inside the nose, Dr. Billings says. But there are several reasons your child’s nose might bleed. 

Allergies and Colds

Your immune system protects you when it detects germs or foreign substances. Mucus gets thick and sticky. Crusting happens when mucus in the nose becomes dry and hard and irritates the mucous membrane.

“Kids get a lot of infections of the upper respiratory tract, which includes the nose,” Dr. Billings says. “They’re also outside playing where they may be exposed to allergens.”

Differences in Nose Anatomy

The nasal septum divides your nose into the left and right nostrils. It is a structure made of bone and flexible tissue called cartilage. Some kids with facial structure differences, such as cleft lip and palate, may develop a shifted septum. 

This condition, known as deviated septum, makes one nostril larger than the other. Differences in nostril size may cause drying and crusting and lead to nosebleeds, Dr. Billings says.

Foreign Object in the Nose

Kids sometimes stick things up their noses. A foreign object lodged in the nose can cause bleeding. It can also cause a yellowish-green or brown discharge that smells bad.   

Nose Picking (Digital Trauma)

Kids may rub or pick their noses. Nose picking disturbs crusted mucus and can cause a cut in the mucous membrane. This behavior is common in kids, Dr. Billings says. “It can also lead to infections called vestibulitis, which can cause bleeding,” she says.

Traumatic Injury to the Nose

Nosebleeds may occur when a child gets hit in the nose. That’s because there are many blood vessels in the nose and they’re very fragile, Dr. Billings says. “Almost all kids who experience trauma to the nose are going to bleed,” she says.

What part of the nose usually bleeds in kids? 

Most nosebleeds in kids occur in the front part of the nose, the anterior septum. It’s unusual for kids to have nosebleeds in the back of their nose (posterior septum). Epistaxis — the medical name for nosebleeds — occurs in the back of the nose most often in adults. 

How to Stop a Nosebleed in a Child

It’s important to stay calm when a child has a bloody nose. Noses can bleed a lot. But a few simple steps help get most nosebleeds under control quickly.

Keep nostrils clear

Don’t stuff anything into your child’s nose to try to stop the bleeding, Dr. Billings says. Instead, gently hold a cloth or tissue under the nose to catch any leaking blood. Stuffing the nostrils with tissue or gauze may cause your child to swallow blood. Swallowing blood can lead to blood getting into the airway and lungs (aspiration).

Have them sit

Tell your child to sit. They can lean forward slightly or rest their elbow on a table or desk. Reassure them that they’re OK. 

Don’t have your child tip their head back. “You don’t want them to swallow the blood,” Dr. Billings says. 

Apply pressure

Firmly pinch the area toward the front of your child’s nose. Keep steady pressure on their nose for about 10 minutes. Many nosebleeds will stop by the end of this time. 

Your child’s nose may still be bleeding after 10 minutes. If it is, apply firm, steady pressure again for another 10 minutes. 

Is a nosebleed an emergency?

Nosebleeds aren’t usually a reason to go to the emergency room, Dr. Billings says. “Most of the time, you don’t need to seek medical attention unless the nosebleed doesn’t stop after 20 minutes of pressure,” she says. 

Emergency healthcare providers may stop the bleeding with gels or sprays that cause blood to clot. They may also inflate a medical-grade balloon inside the nostril to stop bleeding.

Seek immediate medical attention if bleeding doesn’t stop after applying pressure or if your child is:

• Dizzy or faints
• Very pale
• Vomiting blood

How to Prevent Nosebleeds in Kids

Dryness is the root cause of most nosebleeds, Dr. Billings says. Keeping your child’s nasal passages moist helps make nosebleeds less likely.

“If your child has habitual nosebleeds, we definitely recommend starting lubrication,” she says. She advises applying the lubricant of your choice to your child’s nose once or twice a day. Petroleum jelly products are a good option, she says.

“You can apply it with a cotton swab or with the tip of a finger,” she says. “Regularly lubricating the front of the nose is almost always successful in reducing the frequency and severity of nosebleeds in kids.”

Add moisture to the environment

A humidifier can help add moisture to the air in your home. Adding moisture is important if your home is very dry, such as during winter. Humidity helps prevent nasal passages from becoming too dry, Dr. Billings says.

What to Do For Frequent Nosebleeds in Kids

Lubrication is the mainstay of treatment, including for kids with frequent nosebleeds. “Even if a child has a nosebleed a day, we start with lubricants if parents haven’t yet been lubricating their child’s nose,” Dr. Billings says.

Most nosebleeds resolve with regular lubrication. Talk to your pediatrician if your child still has nosebleeds after lubricating their nose regularly for 4 to 6 weeks. Your pediatrician may refer you to an otolaryngologist (ear, nose and throat specialist.)   

Treatments for Recurrent Nosebleeds

A specialist can help determine the cause of nosebleeds in kids when regular lubrication doesn’t stop bloody noses. A specialist examines your child’s nose. They also ask about your child’s health history and any family history of nosebleeds or bleeding disorders.

Chemical Cautery

A specialist may treat recurrent nosebleeds with an in-office procedure called chemical cautery. “It creates a little soft tissue burn to the mucous membrane in the front of the nose,” Dr. Billings says. A specialist will:

• Apply anesthetic: They spray an anesthetic called lidocaine in the affected area. This helps reduce your child’s discomfort.
• Treat the area with silver nitrate: Doctors apply a chemical called silver nitrate to the inside of your child’s nose. This chemical causes the tissue to thicken and reduces the number of blood vessels that may bleed.

Your child may feel some tingling when doctors apply silver nitrate. “They may feel a brief pinchy discomfort,” Dr. Billings says.

Surgical Cautery

Specialists may recommend surgical cautery for children who can’t tolerate an in-office procedure. Doctors give your child medicine (anesthesia) to put them to sleep. They typically use an electric device to heat the nasal tissue and stop blood vessels from bleeding.

Specialists may also insert a thin tube with a light and camera (endoscope) in your child’s nose. “We may use nasal endoscopy to evaluate other sources of bleeding that may be contributing to a child’s nosebleeds,” Dr. Billings says.

Are nosebleeds a sign of a medical condition?

Medical conditions aren’t common causes of nosebleeds in kids, Dr. Billings says. But specialists may perform blood tests when a child has frequent nosebleeds that can’t be controlled. Rarely, specialists may identify:

• Bleeding disorders: Bleeding disorders are conditions that affect how blood clots. People with bleeding disorders bleed easily, including from the nose. 
• Hereditary hemorrhagic telangiectasia: This genetic condition causes blood vessels to develop in ways that aren’t typical. People with this condition may have frequent nosebleeds.

Talk to your child’s pediatrician if you have a family history of bleeding disorders. They may refer your child to a specialist for tests. “Kids with underlying hematologic issues or bleeding problems can get fairly aggressive nosebleeds that may require an intervention,” Dr. Billings says.

Will my child always have nosebleeds?

Some kids get nosebleeds throughout childhood, especially during cold and allergy season.

“I usually tell parents that while there are treatments for nosebleeds, there’s not really a cure,” Dr. Billings says. “We often see nosebleeds run their course and improve as a child gets older.”

Talk to your child’s pediatrician if you’ve tried lubricating your child’s nose regularly and they still get nosebleeds. They may refer you to an otolaryngologist to see if nosebleed treatment can help your child.

Learn more about pediatric otolaryngology care at Lurie Children’s. 

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