Recurrent Nosebleeds in Children
Nosebleeds are very common in children. In most cases they are not dangerous, but they can still be upsetting for children and parents, especially when they happen repeatedly or at night. The reassuring news is that most childhood nosebleeds come from the front of the nose, are self-limiting, and children often grow out of them over time.
In children, the most common site is Little’s area, a fragile area at the front of the nasal septum where small blood vessels sit very close to the surface.
Why do children get recurrent nosebleeds?
The commonest reasons include:
nose picking or rubbing
dry or crusted nasal lining
recent coughs, colds, or upper respiratory infections
allergic rhinitis
irritation from frequent nose blowing
minor trauma
friable surface blood vessels at the front of the nose
Some children simply have a delicate lining inside the nose and a visible blood vessel that keeps breaking open.
In some girls, hormones can also play a part, and nosebleeds may become more noticeable around puberty or at certain times in the menstrual cycle.
What should I do if my child has a nosebleed?
Basic first aid is important and often stops the bleeding.
If a nosebleed starts:
sit your child upright and lean them slightly forward
pinch the soft part of the nose firmly, just below the bony bridge
keep firm pressure on for 10 to 15 minutes without checking too early
ask them to spit out blood rather than swallow it
avoid lying flat or tipping the head back
It is important to pinch the soft part of the nose, not the bony bridge. If pressure is applied over the bony bridge, the bleeding point will not be properly compressed because the bone is solid and does not press the bleeding vessel closed in the right way.
A helpful first-aid video is here:
Why is Naseptin often so helpful in children?
In children, Naseptin ointment has a particularly important role. It is commonly used when nosebleeds are coming from the front of the nose and there is crusting, irritation, or low-grade bacterial colonisation. It can help soften crusts, reduce inflammation, and allow the lining of the nose to heal, which often makes a big difference to recurrent bleeding.
As always, it should not be used if there is a peanut allergy or another reason it is not suitable.
When is examination needed?
A careful history and examination are important if nosebleeds are frequent, severe, one-sided, or not settling with simple treatment.
I usually want to know:
how often the bleeding happens
whether it is one-sided or both-sided
whether there is crusting, discharge, or blockage
whether there are symptoms of allergy
whether the child is picking or rubbing the nose
whether there is bleeding from other sites
whether there is a family history of a bleeding disorder
Most childhood nosebleeds are straightforward anterior bleeds, but recurrent bleeding that is heavy, unusual, or associated with other symptoms deserves proper assessment.
What about bleeding disorders?
Most children with recurrent nosebleeds do not have a serious bleeding disorder. However, it is important to think about this if:
there is bleeding from other sites
there is prolonged bleeding after minor injury
there is a family history of a bleeding disorder
the nosebleeds are unusually frequent, heavy, or difficult to stop
One of the more common inherited bleeding disorders is von Willebrand disease, and nosebleeds can sometimes be one of the ways it presents. That does not mean every child with nosebleeds needs blood tests, but it is something I consider in the right clinical context.
How are recurrent nosebleeds treated in children?
Treatment depends on the pattern of bleeding and what the nose looks like on examination.
First-line treatment
For many children, the first step is:
good first-aid technique
avoiding nose picking and rubbing
treating crusting or irritation
using Naseptin when appropriate
treating allergy if this is contributing
Silver nitrate cautery
If I can see a clear bleeding point at the front of the nose, silver nitrate cautery can be very effective. This is usually the main cautery treatment used in children. It is done after numbing the nose and works by chemical cautery — in simple terms, a chemical is applied to the fragile vessel to seal it.
When used under local anaesthetic, silver nitrate cautery is usually very well tolerated by children.
We do not usually cauterise both sides of the septum at the same time, because this increases the risk of a septal perforation. A septal perforation means a hole developing in the cartilage or tissue that separates the two sides of the nose. For that reason, if both sides need treatment, it is usually done in a staged way with at least 4 weeks between sides so the first treated area can heal properly. Very occasionally, if the areas on each side are not directly opposite one another, both sides may be treated safely, but most of the time I would wait for the first side to heal before treating the second.
Bipolar cautery
Bipolar cautery uses electrical current to generate controlled heat and seal the vessel. In children, this is not typically something done under local anaesthetic in the same way as in adults. If bipolar cautery is needed, it is usually considered in a different setting rather than as routine awake treatment in clinic. This is why silver nitrate generally has the bigger role in paediatric nosebleeds.
When is something more concerning?
Although most childhood nosebleeds are benign, meaning non-cancerous, some patterns deserve more attention.
Unilateral bleeding, especially when it is recurrent and associated with nasal obstruction or persistent blood-stained discharge, needs careful assessment. In a child, that can occasionally raise concern about a foreign body, a structural problem, or more rarely a tumour.
One rare but important condition is juvenile nasopharyngeal angiofibroma, or JNA. This is a rare benign, meaning non-cancerous, but locally aggressive tumour that usually affects teenage boys and commonly presents with recurrent nosebleeds and one-sided nasal blockage.
Will children usually grow out of nosebleeds?
In many cases, yes. Childhood nosebleeds are commonly self-limiting, and many children grow out of them as the nasal lining becomes less fragile and habits such as nose picking improve.
When should urgent medical attention be sought?
Urgent assessment is sensible if:
the bleeding is heavy or does not stop with pressure
the child becomes pale, faint, or unwell
blood is pouring backwards into the throat
the episodes are becoming much more frequent
there is significant blood loss
the child is very young, especially under 2 years old, where nosebleeds are less typical
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.