This article was written by Dr. RP Lindeman, who received a BA from Yale and an MD-PhD from Columbia. He was trained in general pediatrics and pediatric pulmonary medicine at Boston Children’s Hospital. He practiced pediatrics in Massachusetts for over 20 years.
During my 20+ years of practicing pediatrics, I received thousands of calls from parents worried about their children’s nosebleeds. It’s one of the most common reasons I would be called, especially at night.
Blood is scary. No one likes seeing blood from their child’s nose, which often induces panic. Sometimes, I receive a call from an emergency room because the parent panicked.
I can say with a fair degree of confidence that nosebleeds are seldom an emergency. At the end of this post, I will detail the circumstances in which you should take your child to the emergency room for a nosebleed. For now (I’ll say here and repeat it at the end), call your child’s doctor for advice if you have any concerns.
Learning about nosebleeds from the internet
The internet is both a blessing and a curse. We have instantaneous access to almost all the knowledge accumulated over human history. Still, there is also a fair amount of medical misinformation on the internet, including a substantial amount that is untrue.
The internet also has an almost limitless capacity to frighten parents. If you ask Google or ChatGPT to tell you about nosebleeds, you are likely to encounter some terrifying medical conditions. Rest assured that your child is unlikely to have one of these conditions. If they did, it is likely that you already knew about it! The best source of information is your child’s care provider. They can help you tell the difference between good and bad advice. Please remember that your child’s doctor knows your child better than Google does.
Why noses bleed
Children get nosebleeds more than adults do; this happens for several reasons.
First, children tend to pick their noses more than we do (notice I said, ‘more than we do’. I know some readers do it!) They do this because their noses may itch or be irritated. Many kids pick their noses out of habit. These are the patients of mine whose noses bleed most often: they may have scabs that form over the places inside their noses that bled the other day. Then the scab becomes itchy, the child picks their nose again, and the cycle repeats.
Do I need a humidifier?
Dry air in the bedroom is another frequent cause of nosebleeds. In general, houses are more air-tight and dry than when I was a child. The dry air irritates the thin skin covering the inside of a child’s nose and exposes the delicate blood vessels underneath. I’m frequently called by parents who find blood on a child’s pillow for precisely this reason. This post is not about treatments, so I will only say that a cool-mist humidifier by the child’s bed often solves the problem.
Can allergies cause nosebleeds?
Yes, allergies also can indeed cause nosebleeds. The reason requires a little explanation. Allergies in the nose cause swelling of those delicate blood vessels (AKA inflammation). Swollen blood vessels are also more fragile. It takes a lot less to make inflamed blood vessels bleed. If you rely on the internet (see above), you’ll read that children have more allergies than they used to. This is only partly true. There are more allergic children than there used to be; however, the problem is blown way out of proportion. Most of these allergies are mild, and many of them are outgrown. Children who don’t outgrow their allergies tend to get fewer nosebleeds as they grow.
My child has a cold. So, why do they have a nosebleed too?
Just like allergies, colds cause blood vessels in your child’s nose to become inflamed. This is why when a child with a cold blows their nose, it will sometimes cause a nosebleed. It is also the case that children get colds often, especially those in daycare or the early elementary school grades. If this happens to your child, it’s a good idea to reassure them and say that a bit of bleeding when they blow their nose is normal if they have a cold or allergies. This reassurance will help remind the child that it’s better to blow than not to blow when they are congested.
What’s so foreign about foreign bodies?
I saved the best for last. Many children have the endearing habit of putting objects other than their fingers in their noses. If an object can fit into a nostril, some child has tried to insert that object. Because these objects come from outside the child, physicians call them ‘foreign bodies’. That’s unfortunate because there is nothing foreign about these objects. They tend to be items that a child has easy access to.
You cannot do much to prevent a child from putting things in their nose. This type of experimentation and exploration is normal. Nevertheless, it can cause nosebleeds. There are several clever tricks for getting these things unstuck, but they are beyond the scope of this post. It is never a good idea to try inserting tweezers (or even fingernails) into a nose to remove a foreign object. At best, you’re more likely to push the thing deeper. At worst, you’ll irritate the lining of the nose, and it will bleed again!
Every pediatrician has a favorite story about extracting a foreign body from a child’s nose. I have many, but the most memorable was when a little boy put the paper covering of a crayon up his nose. I remember this child well because when I looked up there with my magnifying flashlight, I clearly read the words ‘burnt sienna’ (a shade of brown, according to Crayola).
When should I call the doctor?
Bleeding that does not stop after 15 to 20 minutes of your best efforts requires a call, regardless of the hour of the day. The on-call service provider (doctor or nurse) can often talk you through a technique that might stop the bleeding before a visit to the ER. However, you should go if they recommend taking the child to the emergency room.
Finally, whether the nose is still bleeding or not if you have any questions or concerns, do not hesitate to call your child’s care provider for advice.
