Causes of nosebleeds in children

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A child has a nosebleed: causes, diagnosis, what to do

From this article you will learn answers to the questions: why does a child have a nosebleed, what diseases may be hidden behind this. What additional symptoms may accompany bleeding.

Table of contents:

How to help a child if he has a nosebleed. Further examination of the body and treatment.

Nosebleeds (scientific name: epistaxis) occur when the capillaries found in large numbers in the nasal mucosa are damaged. This damage occurs either as a result of trauma or spontaneously.

The causes and diseases that cause nosebleeds are the same for both children and adults. However, in children this phenomenon is observed more often, since, firstly, in childhood and adolescence the cardiovascular system is still developing, and the capillaries located in the nose may be weak, and, secondly, many diseases that provoke bleeding, They first make themselves known precisely at the age of 18.

According to statistics, about 60% of the world's population has had a nosebleed at least once. Two age groups are most susceptible to nosebleeds: children under 10 years of age and adults over 60 years of age. Boys are more likely to bleed from the nose than girls (such statistics may be due to more frequent nasal injuries in boys due to a more active lifestyle).

Frequent nosebleeds are a dangerous symptom. Sometimes this may indicate serious disorders in the body.

You can completely get rid of nosebleeds by eliminating their cause.

If this symptom appears in a child, contact your pediatrician spontaneously. As a result of an injury, if it is not possible to stop the bleeding for a long time or there is a suspicion of a broken nose, contact a traumatologist.

You may also need to consult an ENT specialist, endocrinologist, hematologist, immunologist, or oncologist. Your pediatrician will refer you to these doctors if necessary.

In most cases, the source of nosebleeds in patients is the Kisselbach plexus.

Why might your nose bleed?

The causes of epistaxis can be divided into three groups:

  1. Local (the cause is located directly in the nose).
  2. Systemic (nosebleeds hide diseases of other organs).
  3. External (the reason lies not in diseases, but in the negative impact of the environment).

Reasons why nosebleeds may occur:

We also note the causes of nosebleeds, which are practically impossible in childhood. This is the use of substances that sharply dilate or constrict blood vessels (alcohol in large doses, energy drinks, cocaine, amphetamine and other drugs inhaled through the nose), as well as hormonal changes during pregnancy.

As you can see, the factors that can cause epistaxis are quite varied - from harmless dry air to serious diseases such as leukemia. Therefore, if this symptom appears spontaneously and frequently, consult a doctor and undergo the examination that he will prescribe for you.

With prolonged use of nasal drops or sprays, the nutrition of the nasal mucosa is disrupted, it becomes thinner, and the vessels become fragile. And with increased blood pressure or injury, nosebleeds occur

Additional symptoms

If the bleeding is heavy, it may be accompanied by the following symptoms:

  • pale skin;
  • dizziness;
  • weakness;
  • cold sweat;
  • sometimes fainting.

How to recognize a “dangerous” nosebleed

By dangerous we mean something that indicates serious illness.

Bleeding caused by diseases is frequent and begins spontaneously.

Vascular diseases and bleeding disorders are often accompanied by bleeding not only from the nose, but also from other mucous membranes. The appearance of bruises even from light blows is also typical.

Epistaxis caused by high blood pressure most often occurs at night.

Sudden, short and intense bleeding (when blood suddenly begins to literally flow in a stream) is dangerous. They may indicate:

  • rupture of a large facial or nasal vessel;
  • malignant tumor of the nasal cavity or paranasal sinuses.
Bleeding due to injury is also not always harmless. If blood comes from the nose as a result of a fall, especially from a height, pay attention to its color:
  • If it is scarlet and foams, this may be a sign of lung damage.
  • If it is dark, close to brown and curled, this may indicate an injury to the esophagus or stomach.

Complications

If there is a heavy nosebleed, a person may faint due to blood loss.

Epistaxis can also be complicated by nausea and vomiting. When blood is released abundantly, it flows down the back wall of the throat and, when it enters the stomach, provokes these unpleasant symptoms.

In severe cases, with very heavy bleeding, blood can enter the nasolacrimal duct and go out through the eye sockets. However, this rarely happens.

If blood comes from both nostrils at the same time, or if the bleeding lasts longer than 10 minutes, call a doctor immediately.

First aid

Rules for stopping nosebleeds:

If the bleeding does not stop within 10 minutes, call a doctor.

A doctor can stop bleeding using the following methods:

  1. Inserting a cotton swab soaked in chloroacetic acid into the nostril.
  2. Insertion of a hemostatic sponge into the nose. It is saturated with substances that promote blood clotting.
  3. Laser coagulation (cauterization) of bleeding vessels.
  4. In severe cases, when it is not possible to stop heavy bleeding, aminocaproic acid is administered intravenously. And, if the patient has lost a lot of blood, a plasma transfusion is performed.

Body examination

If bleeding began as a result of injury or the insertion of a foreign object into the nose, take the patient to a traumatologist. Diagnostics will proceed as follows:

  • The doctor will examine the nose manually and using a rhinoscope.
  • He will send you for an x-ray of the skull.
  • In case of a complex fracture, a CT or MRI of the nose and skull may be needed.

If bleeding occurs spontaneously and regularly, contact your pediatrician. First of all, the doctor will measure your blood pressure, collect data on previous diseases and current symptoms. He will also refer you for a general blood test.

During the initial examination, sometimes it is already possible to accurately determine the cause of nosebleeds or to suspect a possible cause. If all tests during the initial examination are normal and there are no complaints, then perhaps the cause is external (for example, low air humidity).

Depending on the results of the initial examination, the following diagnostic procedures may be prescribed.

Treatment

Specific treatment for epistaxis is to stop the bleeding. This process is described in the First Aid section.

Further treatment consists of eliminating the cause to prevent recurrent bleeding.

If bleeding of the nasal mucosa is caused by health problems, follow all doctor's recommendations regarding further treatment of the underlying disease.

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Are nosebleeds dangerous in children and what is their cause?

Almost every parent has at least once experienced nosebleeds in their child. The reasons for it can be very different, but first aid is based on the same principles that you need to know.

What is nosebleed

Most often, epistaxis, as nosebleeds are scientifically called, occurs unexpectedly and is not a clinical sign of a specific pathology. However, a bloody nose in a child can lead to significant blood loss, which frightens parents. The abundance of blood flowing out is due to the fact that the nasal cavity and its mucous membrane are equipped with a large number of vessels, which in children are quite easily damaged. A child's nose is small, the nasal passages are narrow, the mucous membrane is thin, and there are many closely intertwined vessels in it. These arterial processes form a vascular bundle, which is located in the Kisselbach-Little zone, anatomically it is located within the nasal septum. Most often, bleeding occurs because the vascular bundle of this area is damaged.

Nosebleeds are common in children, so you need to know how to provide first aid

Types of epistaxis

There are two types of bleeding depending on the location of the damaged vessels - anterior and posterior.

  • Anterior bleeding occurs when small vessels that are located in the anterior zone of the nose rupture. Such bleeding occurs in 90% of all cases.
  • Posterior bleeding occurs when larger vessels that are located deeper are ruptured. In this case, there is much more blood and it not only flows out abundantly, but also flows from the nasopharynx directly into the throat. It is very difficult to stop this type of bleeding at home on your own, so you should definitely seek qualified help.

A visual illustration of the differences between anterior and posterior nosebleeds

Video - Nosebleeds and emergency care

Why do such situations arise?

The immediate cause of any bleeding is damage or rupture of the blood vessel wall. After first aid is provided to the baby, it is imperative to figure out why such damage occurred.

The reasons why epistaxis occurs are divided into local and general.

Local reasons

These reasons include:

  • mechanical injuries of the nose - blow, bruise, damage to the nasal cartilage;
  • fracture of the nasal bone or base of the skull due to an unfortunate fall;
  • internal injuries - damage to the mucous membrane (young children like to pick their nose);
  • foreign object in the nose (children often push small buttons, toys, beads into their nostrils);
  • accidental inhalation of insects into the nose;
  • injuries to the mucous membrane during medical manipulations and procedures;
  • congenital curvature of the nasal septum;
  • individual characteristics - superficial location of the vascular network in the nasal cavity;
  • ozena - atrophic rhinitis, when the mucous membrane changes and becomes thin, “overdried”, the blood vessels in it become fragile (the same thing happens with prolonged use of vasoconstrictor nasal drops);
  • various neoplasms in the nose - tumors, polyps, adenoids, hemangiomas or tuberculous erosions;
  • diseases of the upper respiratory tract - sinusitis, sinusitis, rhinitis, in which the mucous membranes swell and become congested.

Often the cause of nosebleeds can be mechanical damage to the nasal mucosa when a child simply picks his nose

General (systemic) causes

One group of reasons is associated with diseases in which the permeability of blood vessels changes and they become brittle:

  • infectious diseases with high fever (influenza, chicken pox, whooping cough, measles, scarlet fever, meningitis, tuberculosis, etc.)
  • vasculitis is a non-infectious disease, the main symptom of which is inflammation of the vascular walls;
  • a hereditary pathology that affects small blood vessels throughout the body - Osler-Rendu-Weber disease;
  • lack of vitamin K and ascorbic acid, as well as some trace elements, especially calcium.

Another group of reasons is an increase in blood pressure, as a result of which the capillary walls are damaged.

This can occur due to the following processes and diseases:

  • severe stress;
  • heavy physical activity;
  • neoplasms in the adrenal glands;
  • inflammatory kidney diseases;
  • pneumosclerosis;
  • emphysema;
  • heart defects (aortic or mitral valve stenosis);
  • hypertension;
  • atherosclerotic changes in blood vessels.

The third group of causes are blood diseases:

  • coagulation disorders in hemophilia, hemorrhagic diathesis;
  • leukemia, anemia;
  • thrombocytopenic purpura;
  • agranulocytosis;
  • liver diseases, in particular cirrhosis, and some other pathologies that affect the process of blood clotting.

Another group of reasons:

  • disorders of the central nervous system;
  • severe sneezing or coughing;
  • hereditary pathology - lupus erythematosus;
  • too dry air, due to which the mucous membrane dries out, vascular walls become brittle and are easily damaged;
  • hormonal changes in teenage girls;
  • overheating of the body - heat or sunstroke;
  • taking certain medications that affect blood vessels and blood:
    • corticosteroids;
    • heparin;
    • antiallergic drugs;
    • aspirin;
    • vasoconstrictor drops;
  • burns of the mucous membrane;
  • exposure to radiation;
  • prolonged inhalation of harmful vapors or gases;
  • changes in atmospheric pressure - when climbing to a height or diving.

Sometimes bleeding from the lungs, esophagus or stomach is confused with epistaxis.

What frightens parents most is nighttime nosebleeds in children. If there was no previous injury, then the causes of such bleeding may be:

  • drying out of the nasal mucosa due to very dry and hot air in the bedroom (especially during the heating season);
  • allergic reactions to house dust, household chemicals, washing powder used for washing bed linen;
  • long-term use of vasoconstrictor drops.

Nighttime manifestations may indicate functional disorders of the nervous system or blood coagulation system, so the baby must be shown to a specialist.

Treatment

Treatment is aimed at stopping bleeding and eliminating the causes that caused it. Most often, minor bleeding can be stopped on your own, but if this cannot be done, and the blood does not stop for more than 20 minutes, while flowing in a continuous stream, you need to call an emergency vehicle. In this case, the ambulance will take the child to the ENT department of the hospital on duty, where the doctor will provide first aid and prescribe drug therapy, if necessary. If bleeding began after the child suffered a head injury, an emergency vehicle should be called immediately.

Cryotherapy (cold cauterization) is an effective method for treating recurrent nosebleeds

If a child’s bleeding is caused by a foreign object in the nose, you should not remove it yourself, this can lead to a worsening of the child’s condition and even more bleeding. Removal of a foreign object should only be done by an ENT specialist in a hospital setting.

Parents should not ignore recurring bleeding; the child must be shown to specialists. First of all, an otolaryngologist, then a cardiologist, a neurologist, a hematologist, an ophthalmologist, and in case of injury, a surgeon.

Treatment is carried out in three directions:

  1. prompt stop of bleeding;
  2. carrying out drug therapy;
  3. if possible, eliminate the cause of the bleeding.

Hemostatic drugs are used for treatment. In case of severe bleeding and large blood loss, intravenous drip solutions are used to replenish blood volume. A hemostatic sponge, fibrin film, or BAP (biological aseptic tampon) are used locally.

Nasal tamponade

The doctor may resort to anterior or posterior nasal tamponade if the treatment has no effect and the bleeding cannot be stopped. Before the procedure begins, anesthesia is administered. Anterior tamponade is carried out with gauze or special latex tampons. The material is abundantly moistened with a 3% solution of hydrogen peroxide, a 5% solution of aminocaproic acid or sterile vaseline oil. If, at the end of the manipulation, blood continues to flow down the nasopharynx, posterior tamponade is performed using a special technique. Tampons are left in the nasal cavity for up to two days. To avoid the development of infection, tampons, in addition to hemostatic drugs, are additionally impregnated with antiseptic drugs - Dioxidin, Iodoform, Feracryl.

An effective method for stopping heavy nosebleeds is anterior nasal tamponade.

Coagulation

If the bleeding is recurrent and of the anterior type, the otolaryngologist may suggest coagulation (cauterization) of the nasal mucosa. Manipulation is carried out using different methods - laser, liquid nitrogen (cryodestruction), electricity (electrocoagulation), ultrasound, trichloroacetic acid. The manipulation is carried out with preliminary anesthesia.

Surgery

If there is no effect from the procedures performed, doctors may resort to surgical intervention: removal of vascular bundles, injection of medicinal solutions under the mucous layer of the nasal septum, peeling off the mucous layer, ligation of individual vessels in case of repeated bleeding with large blood losses.

First aid for a child with bleeding

The very first thing to do is to calm the child. The sight of blood can be very frightening for your baby, and crying and stress can make the bleeding worse.

  • Sit the victim down and tilt his head slightly forward, and pick up a small child.
  • Loosen the tight parts of the clothing, unfasten the top buttons.
  • Provide a flow of fresh air - open the window, explain to the baby how to breathe correctly - deeply, calmly.
  • Apply cold to the bridge of the nose - a napkin or towel moistened with cold water; you can place a bubble or plastic container with ice or a hypothermic bag on top of a dry napkin. Cold constricts blood vessels.
  • Warm your feet by applying a hot heating pad or placing them in a bowl of warm water. Thanks to this, the vessels of the lower extremities will dilate and blood will flow to the lower part of the body.
  • Press the wings of the nose with your fingers - on one or both sides, depending on how the blood flows out - from one nostril or both. Wait 7–10 minutes. During this time, a blood clot should form that will block the damaged vessel.
  • If there is a lot of blood, moisten a gauze swab or cotton ball with a 3% hydrogen peroxide solution and place it shallowly in the nostril. To wet the tampon, you can use any drops with a vasoconstrictor effect - Naphthyzin, Mezaton, Farmazolin, Otrivin.

When you have a nosebleed, do not throw your head back

What not to do

  • Putting your child to bed and elevating his legs will increase bleeding.
  • Throwing your head back increases the flow of blood from the nose due to the disruption of venous outflow through the neck veins; moreover, blood will enter the throat and can cause spasms and vomiting.
  • Feed and water the child immediately after bleeding stops, especially give hot drinks. Bleeding may start again because eating and drinking will cause increased blood pressure and dilation of blood vessels.
  • After stopping the bleeding, you need to relieve the child from excessive physical activity, limit sports and active games.

If all of the above measures do not help and the bleeding does not stop, you need to call an ambulance.

Calling an ambulance is justified in the following cases:

  • the bleeding does not stop for more than 20 minutes, despite first aid;
  • the blood flows in a stream, without clots;
  • large blood loss;
  • bleeding was preceded by injury to the head or nose;
  • fainting or deterioration in health - weakness, dizziness, nausea, vomiting;
  • there is a suspicion of a foreign body in the nose;
  • exacerbation of chronic liver or kidney diseases;
  • ARVI with high fever;
  • taking medications that affect blood clotting.

Drugs for treatment

In case of massive nosebleeds and the ineffectiveness of priority measures to stop it in a hospital setting, hemostatic (hemostatic) drugs are used:

  • Vikasol in tablets or intramuscularly;
  • calcium supplements (calcium chloride or calcium gluconate) intravenously;
  • epsilon-aminocaproic acid locally or intravenously;
  • Dicynone (Etamsylate) in tablets or intramuscularly.

Prevention at home

In order to save your baby from unpleasant moments in the form of nosebleeds, you need to perform simple preventive measures:

  1. Humidify the air in a living room using a special humidifier or improvised means - open containers with water next to heating devices.
  2. Moisturizing the baby's mucous membrane - apply Aquamaris, Salin, Humer or saline solution several times a day.
  3. Daily walks in the fresh air.
  4. A nutritious diet rich in vitamins: the table should have fruits, vegetables and protein-rich foods on the table all year round - meat, liver, dairy products, cheese, cottage cheese.
  5. Strengthening blood vessels - hardening, contrasting local and general douches, as prescribed by a doctor - vitamin C, Ascorutin.

Nosebleeds can be not just a small local pathology, but also a symptom of a serious illness. If bleeding occurs frequently, it is necessary to thoroughly examine the baby to establish an accurate diagnosis and carry out appropriate treatment.

  • Author: Elena Yalynich
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Nosebleeds in a child: causes and treatment

Nosebleeds in children always frighten both parents and the children themselves. So, blood from the nose can be the result of a simple wound on the nasal mucosa, or indicate more serious health problems.

What happened to the child, what is the cause of the bleeding, how to help? Many are lost, not knowing what to do or how to provide first aid. To behave correctly in such a situation, read this article.

Types of nosebleeds

There are two types of nosebleeds: anterior and posterior. The first type (anterior) is the most common and accounts for about 90% of all nosebleeds. It is characterized by a calm flow of blood when the vessels in the front of the nose are damaged. The second type (posterior) is much less common - in 10% of all cases. Such bleeding occurs due to damage to larger and deeper vessels, while blood intensively flows down the back wall of the pharynx. It is more difficult to stop, it is more abundant, and therefore it is advisable to urgently seek qualified medical help without trying to cope with it yourself.

Not far from the nasal entrance, in the anterior section of the nasal septum, there is a small Kisselbach area (the size of a penny coin). It is rich in blood vessels, its mucosa is looser and thinner than in other areas. Therefore, it is very easy to break the membrane and cause nosebleeds in this particular area of ​​the vascular plexus. This is what happens in most cases.

Causes of nosebleeds

The direct cause of any bleeding is the same - rupture of a blood vessel. But what triggered it needs to be figured out as soon as the child is given first aid.

Nosebleeds can occur for many reasons. They can be divided into two groups – local and general. Local reasons include the following factors:

  • trauma to the nose (bruise, fracture of cartilage tissue) or fracture of the base of the skull;
  • internal damage to the mucous membrane (pencil, match, finger, nail);
  • foreign body - parasite (in particular, when worm larvae migrate, the walls of blood vessels are damaged), inhalation of small insects, ticks, small objects;
  • injury during surgical operations or therapeutic and diagnostic procedures, for example, during probing or catheterization;
  • deviated nasal septum is a congenital defect;
  • anomaly in the development of blood vessels (local dilatations) or their location is too superficial;
  • degeneration of the nasal mucosa with atrophic rhinitis;
  • neoplasms in the nasal cavity (tumors), polyps, adenoids, tuberculous ulcers, hemangiomas and specific granuloma;
  • ENT diseases (sinusitis, chronic rhinitis, sinusitis, adenoiditis), which are accompanied by congestion of the mucous membrane.

Common causes can occur under various conditions:

  1. Fragility of vascular walls, when vessels are easily damaged as a result of the slightest tension in them:
  • infectious diseases occurring against a background of high temperature (chickenpox, measles, scarlet fever, rubella, whooping cough, influenza, meningococcal meningitis, tuberculosis, etc.);
  • vasculitis (non-infectious inflammation of the walls of blood vessels);
  • Osler-Rendu-Weber disease (hereditary pathology, a type of hemorrhagic diathesis, characterized by underdevelopment of the walls of blood vessels);
  • lack of vitamins, especially ascorbic acid and vitamin K, as well as calcium.
  1. An increase in blood pressure at which the capillary wall ruptures:
  • physical and emotional overload;
  • adrenal tumors;
  • emphysema and pneumosclerosis;
  • chronic kidney diseases – glomerulonephritis and pyelonephritis;
  • aortic and mitral stenosis (heart defects);
  • some other congenital heart defects;
  • atherosclerosis;
  • hypertonic disease.
  1. Blood diseases:
  • disorders in the mechanism of blood clotting, for example, with hemophilia, coagulopathies, hemorrhagic diathesis;
  • leukemia or aplastic anemia;
  • Werlhof's disease (thrombocytopenic purpura) – decreased number of platelets in the blood;
  • liver cirrhosis and other chronic diseases that affect blood clotting;
  • agranulocytosis (decreased number or complete absence of leukocytes in the blood).
  1. Other reasons:
  • migraines and nervous disorders;
  • severe coughing and sneezing (contribute to a sharp increase in pressure in the vessels of the nose, which can cause them to burst);
  • systemic lupus erythematosus (a hereditary disease resulting from failures in the immune system);
  • changes in hormonal levels during adolescence in girls, during which there is an increased production of the sex hormones estrogen and progesterone;
  • dry air in the room, when the nasal mucosa dries out, atrophies, and the vessels become brittle;
  • sunstroke or heatstroke (they are usually accompanied by tinnitus, weakness and dizziness);
  • frequent tamponade of the nasal cavity, as a result of which atrophy of the mucous membrane develops, and as a result, bleeding begins;
  • taking certain medications - vasoconstrictor nasal drops, antihistamines, corticosteroids, Heparin, Aspirin.
  1. Rare causes of nosebleeds in children include:
  • exposure to radiation;
  • chemical, thermal and electrical burns of the nasal mucosa;
  • chronic intoxication of the body with harmful vapors and gases contained in aerosols and various chemicals;
  • changes in barometric pressure, for example, during mountaineering or swimming at depth.

Sometimes bleeding from the esophagus, stomach and lungs, when blood flows through the nose and mouth, is mistaken for nosebleeds.

Symptoms

Nosebleeds practically do not require diagnosis, in contrast to the reasons that caused it.

In addition to the signs of the underlying disease, several symptoms can be identified:

  • pure scarlet blood flowing from the nose;
  • ringing or noise in the ears;
  • dizziness;
  • flickering of flies before the eyes;
  • shortness of breath, rapid breathing;
  • heartbeat;
  • discomfort in the nose;
  • headache;
  • thirst;
  • general weakness.

Bleeding from the back of the nose may cause hemoptysis and vomiting of blood.

Typically, nosebleeds are one-sided, but in severe cases, blood can fill the entire nostril and move into the other nostril. In this case, it will flow from both nostrils, even if the vessel is damaged on only one side.

Diagnostics

Only a pediatric ENT doctor can determine the type of bleeding using rhinoscopy and pharyngoscopy. After the bleeding has stopped, you should begin to search for the causes, that is, thoroughly examine the child:

  • take blood tests;
  • consult a pediatrician and pediatric specialists (hematologist, endocrinologist, cardiologist, immunologist, oncologist).

Complications

With heavy nosebleeds, hemorrhagic shock may develop:

  • a sharp decrease in blood pressure as a result of large blood loss;
  • confusion or loss of consciousness;
  • tachycardia;
  • pronounced pallor of the skin;
  • weak thready pulse.

To objectively assess the child’s condition after blood loss, it is necessary to do a general blood test and a coagulogram.

Frequently recurring nosebleeds can lead to serious consequences:

  • general exhaustion of the body;
  • development of anemia;
  • decreased immunity.

Chronic oxygen starvation in the case of nosebleeds leads to disruption of the functioning of various organs, as well as to the development of irreversible pathological changes in their structure.

If such health problems are ignored, death can occur.

Helping a child with nosebleeds

Anterior nosebleeds stop almost immediately and almost on their own. But still some manipulations are required:

  • calm the child down, sit him on a chair, and pick up the little ones;
  • unbutton clothes, try to let the child inhale through the nose and exhale through the mouth;
  • feet should be warm;
  • tilt your head slightly forward and pinch your nostrils with your fingers;
  • throw back your head, but be sure to put cold on the bridge of your nose and insert a tampon into your nose;
  • put cold on the back of your head;
  • make a small swab from cotton wool or a bandage, moisten it in a 3% solution of hydrogen peroxide or in vasoconstrictor drops and insert it into the nostril;
  • if there is no hydrogen peroxide, drip vasoconstrictor drops into the nose - Galazolin, Naphthyzin, Rinazolin or 0.1% adrenaline solution;
  • if the bleeding continues, then in a minute you need to call an ambulance.

As soon as the bleeding stops, the tampon should not be pulled out abruptly: this can damage the blood clot, and the blood will start flowing again. It is best to moisten it with hydrogen peroxide and then remove it.

Then, twice a day, lubricate the nasal mucosa with Vaseline (or Neomycin, Bacitracin ointment) to prevent it from drying out again and to promote better healing, which can last from 1 to 5 weeks.

If the air in the apartment is dry, especially during the heating season, it is recommended for the child to instill sea water-based products - Salin or Aquamaris - into the nose.

After stopping the bleeding, the child must be shown to an ENT doctor to prevent recurrences. He will examine the baby, if necessary, he will cauterize the bleeding area, and if necessary, he will send him for a full examination to find out the reasons.

If there is bleeding, you should not:

  • blow your nose, this will dislodge the clot that forms, and the blood will flow again;
  • throw your head back, as blood will flow down the back wall of the throat, enter the stomach or block the airways; in the first case, vomiting may occur, and in the second, suffocation;
  • if the cause of bleeding is a foreign body, you cannot remove it yourself, as it can become dislodged and cause suffocation.

Indications for calling an ambulance:

  • bleeding does not stop within minutes;
  • there has been a head injury, after which blood comes from the nose along with a clear liquid (suspicion of a fracture of the base of the skull);
  • intense bleeding, blood flows out in a stream, a clot does not form;
  • there is hemoptysis (posterior bleeding) or vomiting of blood (bleeding from the esophagus);
  • foamy blood (pulmonary hemorrhage);
  • in addition to bleeding, vomit the color of coffee grounds occurs, which indicates gastric bleeding;
  • the child (teenager) often has high blood pressure;
  • a child whose nose is bleeding suffers from diabetes;
  • the baby fainted;
  • a small patient receives drugs that reduce blood clotting - Aspirin, Indomethacin, Ibuprofen, Heparin, etc.;
  • the child has hemophilia or other diseases affecting the blood clotting mechanism.

Medical assistance

To stop intense nosebleeds, an ENT doctor can take the following measures:

  • anterior or posterior tamponade impregnated with a 1% solution of feracryl, preserved amnion, epsilon-aminocaproic acid;
  • remove a foreign body or polyps if they appear and cause nosebleeds;
  • insertion of a tampon with trichloroacetic acid or vagotil, which cauterizes the vessels, thus stopping bleeding;
  • coagulation (cauterization) of the bleeding area of ​​the mucosa using one of the following methods: laser, ultrasound, electric current, liquid nitrogen, silver nitrate, chromic acid;
  • use of a hemostatic sponge in the nasal cavity;
  • in case of heavy blood loss - transfusion of donor blood, fresh frozen plasma, intravenous administration of rheopolyglucin, hemodez and aminocaproic acid;
  • if the measures taken are ineffective, surgical intervention is indicated - ligation or embolization (blockage) of large vessels that supply blood to the problem area of ​​the nasal mucosa;
  • endoscopic cryodestruction;
  • administration of sclerosing drugs, oil solution of vitamin A;
  • oral administration of drugs that increase blood clotting - calcium chloride, Vikasol, ascorbic acid, calcium gluconate.

In case of intense bleeding or massive blood loss, the child must be hospitalized in the ENT department.

After a nosebleed, children should not exercise for several days or consume hot drinks or foods. This causes a rush of blood and lymph to the head, which can cause bleeding again.

Prevention

Prevention of nosebleeds should be carried out based on the reasons that cause them. General measures include:

  • the use of Ascorutin, which strengthens the walls of blood vessels;
  • good nutrition, inclusion of vegetables, fruits, cereals, meat, fish in the diet; eating foods rich in vitamins and minerals;
  • air humidification, regular checking and cleaning of the air conditioner;
  • injury prevention;
  • the use of drugs that help moisturize the nasal mucosa, especially in children suffering from frequent colds and allergies.

Summary for parents

In order not to get confused when a child has a nosebleed, you should thoroughly study the technique of necessary first aid, as well as constantly carry out preventive measures to strengthen the child’s vascular wall.

Which doctor should I contact?

In case of nosebleeds that do not stop within 15 minutes, you need to call an ambulance, which most often, after providing first aid, transports the child to a surgical hospital, where he is examined by an ENT doctor. If bleeding is regular, you need to contact a pediatrician and systematically examine the child with the involvement of the necessary specialized specialists: hematologist, neurologist, rheumatologist, endocrinologist, oncologist, infectious disease specialist, cardiologist, hepatologist.

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The information is provided for informational purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Editorial office address: Moscow, 3rd Frunzenskaya st., 26

Source: http://myfamilydoctor.ru/nosovoe-krovotechenie-u-detej/

Nosebleeds in children: causes, treatment, first aid

The most common spontaneous bleeding is nosebleeds. They are often observed in children of different age groups. The nature and frequency of nosebleeds does not depend on the gender of the child. According to statistics, the reason for hospitalization in an ENT hospital in 5–10% of all cases is nosebleeds.

Nosebleeds can occur suddenly, sometimes even during sleep. It can be one- or two-sided, with different duration and intensity: blood can flow slowly or in a stream. In some cases, bleeding may be short-lived and stop spontaneously.

Sources of nosebleeds

Children have narrow nasal passages and easily vulnerable delicate mucous membranes in the nasal cavities. Blood supply is provided by branches of the carotid arteries, which are intertwined in the mucosa.

One of these vascular weaves (Kiesselbach's area) is formed in the anterior sections on both sides of the nasal septum, where the mucosa is especially thin. It is this, located superficially, that is easily injured and is the source of nosebleeds in 90%. That is why it is called the bleeding zone.

This type of bleeding is called an “anterior” nosebleed. It is usually not intense, can stop on its own, and usually does not pose a threat to life. But still, frequent bleeding can cause anemia, which is important for a growing body.

Bleeding can also occur from a deeper section (the so-called posterior bleeding), from larger vessels. It can be very abundant and does not stop on its own. It develops in rare cases in children.

The intensity of blood loss increases quite quickly and can become life-threatening. The child may lose a liter of blood or more. Stopping blood loss is possible only with special medical procedures.

Causes

Nosebleeds may be associated with:

  • with damage to the integrity of the vessel wall due to injury or increased permeability;
  • with pathology in the blood coagulation system.

Bleeding can occur spontaneously or be provoked by an external action. The causes of nosebleeds are divided into general and local.

Local reasons include:

  1. Injuries of varying nature and severity: from damage to blood vessels by a child’s fingers when picking his nose to fracture of the nasal bones.
  2. Foreign body in the nose: with direct damage to the mucous membrane and blood vessels or due to an inflammatory process during prolonged stay of a foreign body in the nose. More often this is typical for children at a young age, who are capable of putting all sorts of objects into their noses, which is not always known to parents. Bloody discharge is combined with purulent discharge that has an unpleasant odor.
  3. Neoplasms in the nasal cavity (in children, most often benign).
  4. A deviated nasal septum is characterized not only by bleeding, but also by difficulty breathing through the nose.
  5. Anomalies in the development of blood vessels in the nasal cavities - local dilations of venous or arterial vessels.
  6. Structural changes in the mucosa during chronic rhinitis and some infections (diphtheria, whooping cough, tuberculosis).
  7. Damage to the mucous membrane and blood vessels when drying out due to dry air in living quarters: the mucous membrane fuses with the vascular wall and ruptures when blowing the nose or sneezing, damaging the fused vessel.
  8. Medical operations and procedures (puncture of the paranasal sinuses, removal of adenoids).

General causes can be various diseases and conditions leading to disturbances in blood clotting processes or increased permeability of vascular walls:

  1. Diseases of the blood and coagulation system (hemophilia - a genetic disease consisting in the absence of a blood clotting factor; other coagulopathies).
  2. Vasculitis (inflammation of blood vessels, accompanied by increased permeability of their walls), characteristic of some severe infections (influenza, measles, etc.).
  3. Lack of vitamins C or K, calcium deficiency, which increase vascular permeability.
  4. Liver pathology in the stage of decompensation (chronic hepatitis, cirrhosis).
  5. Chronic sinusitis, adenoiditis, atrophic rhinitis.
  6. Conditions and diseases that occur with high blood pressure: kidney pathology, hypertension, significant physical activity, overheating, sunstroke.
  7. High fever.
  8. Significant changes in atmospheric pressure (when flying on an airplane, when climbing mountains).
  9. Hormonal changes in adolescents.

Nosebleeds that appear may be an early manifestation of serious diseases and have a recurrent course.

In any case, even if it was possible to stop the bleeding at home, the child must be shown to a pediatric ENT doctor to determine the cause of the pathology. Sometimes consultations with doctors of other specialties (pediatrician, hematologist) and laboratory tests may be necessary.

Symptoms

During a nosebleed, blood flows out of the nasal passages. The amount of blood can vary - from a few drops to flowing out in a stream. Some of the blood drains into the pharynx, and this may cause the degree of blood loss to be underestimated.

When bleeding from deep parts of the nasal cavities, all the blood can drain to the back wall of the pharynx and be swallowed. Subsequent bloody vomiting may be the first manifestation of nosebleeds.

The general condition depends not only on the amount of blood loss, but also on the initial state of health and the age of the child. The younger the age, the more severe the blood loss. Blood loss in weakened children can be a serious health challenge.

The intensity of bleeding also matters. A small amount of blood lost may not affect the child’s condition at all. But an impressionable, easily excitable baby can be frightened by the sight of blood and react violently to bleeding, even to the point of fainting.

With rapid and massive blood loss, weakness, ringing in the ears, dizziness, and thirst appear. There is increasing pallor of the skin and increased heart rate. If the bleeding is not stopped, blood pressure drops, shortness of breath appears, loss of consciousness occurs as a result of severe oxygen starvation of the brain tissue - hemorrhagic shock develops.

In some cases, when blood is discharged from the nose, the source of bleeding is another organ - the respiratory organs (bronchial tubes or lungs) or digestive organs (esophagus, stomach). But when there is bleeding from the bronchi or lung, a cough is noted, and the blood is scarlet in color and foams. With stomach bleeding, the blood is dark, like coffee grounds.

First aid

If nosebleeds occur, you should:

  1. Calm the child, because excitement from the sight of blood will cause increased heart rate and increased blood pressure, which will increase bleeding and increase blood loss.
  2. Place the child in a sitting or reclining position, with his head slightly lowered down, so that the blood does not flow into the respiratory tract or esophagus, but flows out of the nostrils. In a horizontal (lying) position, the flow of blood to the head will increase and the bleeding will intensify.

You should not throw your head back (a common mistake made by adults when children are bleeding): blood will flow into the throat, and the child may choke on the blood or swallow it. The resulting coughing or vomiting will increase the bleeding. It is better to take a small child in your arms and support his head.

  1. Place a container for the leaking blood (to determine the volume of blood loss), explaining to the child that blowing his nose and swallowing blood is prohibited.
  2. Unbutton tight clothing for better air access. Explain to an older child the need to inhale through the nose and exhale through the mouth.
  3. Having determined which nasal passage the blood is flowing from, press the wing of the nose against the septum with your fingers for 5–10 minutes to form a thrombus (blood clot).
  4. Apply cold to the nose area (a napkin or rag soaked in cold water, or pieces of ice in a plastic bag) to reduce blood flow.
  5. If the effect is not achieved, then you need to insert a sterile cotton swab into the nasal passage, after moistening it in a 3% solution of hydrogen peroxide, and press the wing of the nose again. You can use a 0.1% solution of adrenaline or any solution of vasoconstrictor drops (Otrivin, Naphthyzin, Tizin, Galazolin, Sanorin) for wetting.
  6. If there is bleeding from the right nasal passage, you need to raise the child’s right hand up, and with the finger of his left hand he will press the bleeding wing of the nose; if there is bleeding on the left, vice versa. If both halves of the nose are bleeding, the child will raise both hands up and the parent will press both nostrils.

If a foreign body is found in the nasal passage that causes bleeding, then you should not remove it yourself due to the danger of displacement into the respiratory tract and subsequent suffocation. Only an ENT doctor should remove a foreign body.

When providing assistance, you need to monitor the child’s condition, monitor pulse and blood pressure. If the bleeding has been stopped, then using a cotton swab you need to carefully lubricate the mucous membrane in both nasal passages with petroleum jelly to prevent the mucous membrane from drying out. The child must be given plenty of water to replenish the volume of circulating blood.

It is also necessary to take care of humidifying the air in the room by using air humidifiers. You can simply hang wet sheets. Drops of Aquamaris and Salin will protect the mucous membrane from drying out.

Treatment

If the measures taken do not stop the bleeding within 15 minutes, it is necessary to call an ambulance and hospitalize the child in the ENT department, where specialized medical care will be provided.

Indications for urgently calling an ambulance are as follows:

  • nasal injury in a child;
  • intense bleeding and the threat of massive blood loss;
  • discharge of clear fluid with blood after a head injury (possible fracture of the base of the skull);
  • diabetes;
  • hemophilia or other pathology of the blood coagulation system;
  • bleeding developed due to the use of heparin, ibuprofen, aspirin, indomethacin or other drugs that impair blood clotting;
  • resumption of bleeding after it stops;
  • bleeding due to high blood pressure in children;
  • vomiting blood or foamy blood coming from the nose;
  • loss of consciousness due to bleeding.

In a hospital, if there is bleeding from the anterior part of the nose, it can be stopped by coagulating (cauterizing) the bleeding vessel with a laser, liquid nitrogen or electricity (electrocoagulation).

Indications for vascular coagulation:

  • frequent nosebleeds;
  • lack of effect from attempts to stop bleeding by other methods;
  • very heavy bleeding;
  • development of anemia with repeated bleeding.

If there is bleeding from the posterior nasal cavity, the doctor may perform posterior tamponade of the nasal cavity and use hemostatic drugs (Vikasol, sodium etamsylate). For therapeutic and prophylactic purposes, Ascorutin, calcium supplements, and vitamin A are prescribed in the form of an oil solution in the nose.

In case of massive blood loss, solutions are administered intravenously to restore the volume of circulating blood. If necessary, components of donor blood are transfused.

If a foreign body is present, it is removed. In rare cases, it is necessary to use surgical methods - embolization or ligation of a bleeding vessel.

In the hospital, a complete examination of the child is carried out to clarify the cause of bleeding.

Traditional medicine recipes

  • Squeeze the juice from yarrow leaves and drop it into your nose;
  • 2 tbsp. l. dried spring bedstraw grass, pour 0.5 liters of water, boil for 10 minutes, leave for 1 hour, take half a glass three times a day;
  • 1 tsp. geranium leaves pour 200 ml of water, bring to a boil, let it brew for 2 hours, moisten the swab and put it in the nose to stop bleeding;
  • grind 4 tsp. viburnum bark per 200 ml of water, boil for half an hour, strain and add boiled water to the initial volume; take 1 tbsp. l. 3 times a day before meals;
  • crushed dry nettle leaves (1 tbsp) pour 200 ml of boiling water, let it brew for 10 minutes, strain, drink 1 tbsp. l. 3 times a day;
  • 1 tbsp. l. nettle leaves pour 200 ml of boiling water, boil for 10 minutes, cool, strain, drink 1 tbsp. l. 4 times a day.

An alternative treatment method for nosebleeds is acupressure of biologically active points (Su Jok therapy). Using a match, you need to massage the pads of your thumbs on the palm of your hand, where the point of the nose is located. Then tighten this point with a thick black elastic band and leave for a few minutes. Glue a pea of ​​black pepper onto this point and continue massaging it. Carry out the same actions with your big toes.

Summary for parents

Nosebleeds in children are a problem for many parents. Single or recurrent, they require consultation with a pediatric ENT doctor to determine the cause.

Only minor bleeding can be stopped on your own. Parents should know the rules and be able to provide first aid in case of bleeding in order to correctly assess the situation and promptly seek qualified medical help.

How to provide first aid to a child with a nosebleed, the program “Doctor Komarovsky’s School” tells:

Source: http://otolaryngologist.ru/1937