Epistaxis in a child: causes and treatment

The most common bleeding occurring spontaneously is nasal. They quite often occur in children of different ages. The reason for hospitalization in an ENT hospital in 10-15 percent of cases is precisely this problem.

Types of nosebleeds in children

Bleeding from the nose can be from the back or the front. In the first case, the causes are usually trauma, high blood pressure or some serious illness. Bleeding from the anterior nasopharynx is not so dangerous, as it usually occurs when a vessel that is located on the septum is damaged.

Causes of Sudden Bleeding

In almost 90 percent of cases, the cause of nosebleeds in children is bursting vessels in the anterior regions. The vascular plexus, located superficially in the septum, is easily damaged. Also, bleeding can be associated with the influence of several negative factors:

• excessive dryness of some areas of the nasal mucosa (the mucosa loses its elasticity, strength, and may be damaged by minor exposure);
• very hot and dry indoor air (as a result, the mucous membrane dries up);
• inhalation of tobacco smoke, dust, small particles of animal hair (also irritating to the nasal mucosa);
• the formation of mucus and the fragility of blood vessels on the septum (it can be either a consequence of the action of irritating factors or caused by various health problems);
• pressure drops, for example when climbing mountains or flying in an airplane;
• high temperature in a child can also cause bleeding;
• hormonal changes occurring in adolescence;
• too much physical exertion or strong emotional experiences, stress (provoke an increase in blood pressure).

Often there is bleeding due to trauma (and it can be of a different nature and strength) or if a foreign body enters the nose. In the first case, both blood picking in the nose with a finger and bone fracture can provoke the appearance of blood. Even if the child blows his nose too hard, bleeding may occur. As for the second option, children, and especially small ones, can stick an object in their nose, which parents do not always immediately know. Discharges in this case appear with pus, have an unpleasant odor.

These are the most common causes of bleeding, which are relatively easy to eliminate. But frequent nosebleeds in a child can occur as a result of other more dangerous conditions, health problems. In this case, you will definitely need to see a doctor so that the specialist makes an accurate diagnosis and prescribes the appropriate treatment. The following causes can lead to frequent nosebleeds in children:

1. Various blood diseases. For example, hemophilia is a congenital disease that is characterized by a complete absence or significant violation of blood coagulation.
2. Increased vascular permeability as a result of an inflammatory process (for example, with vasculitis) or with serious diseases (measles, flu, etc.), some hereditary diseases, vitamin C hypovitaminosis (lack of ascorbic acid).
3. Chronic pathologies that disrupt the liver (cirrhosis or hepatitis, for example).
4. Chronic diseases of the paranasal sinuses or nasal cavity, having an inflammatory nature.
5. Various conditions that are accompanied by an increase in blood pressure. This may be physical activity, renal hypertension, sunstroke or general overheating of the body).
6. Changes in the structure of the mucosa caused by various infections (e.g. syphilis, diphtheria, or tuberculosis) or chronic runny nose.
7. Various benign and malignant tumors in the nasal cavity. For children, as a rule, neoplasms having a benign character are characteristic.

In addition, the causes of nosebleeds in children can be determined by the anatomical features of the structure of the nasal septum, abnormalities in the development of the vascular system of the nose, and the curvature of the nasal septum. In the latter case, difficulty breathing is also observed.

Opinion of Dr. Evgeny Olegovich Komarovsky

A pediatrician of the highest category and presenter of the program “School of Dr. Komarovsky”, whose opinion many parents trust, also spoke about nosebleeds in children. Komarovsky notes that the tendency to nosebleeds is often determined precisely by the anatomical features of the structure of the mucous membranes, in particular the depth of the location of the vessels and their diameter.

Blood can come from both the front and back of the nose. According to Evgeny Olegovich, the vast majority of the manifestations of this symptom in childhood are caused by damage to a vessel located in the nasal septum. This is bleeding from the front of the nose. Variants when blood comes from the back, in childhood, are relatively rare, but always dangerous. In this case, Komarovsky calls the cause of nosebleeds in children the manifestation of serious diseases of the internal organs, which are accompanied by disorders of the blood coagulation system and vascular damage.

Here is the most convenient symptom that will help parents determine whether blood from the nose is a danger: posterior bleeding is almost always from both nostrils, the front, usually from one. Frequent nosebleeds in a child is an unambiguous reason to contact a specialist as soon as possible for examination, diagnosis and appropriate treatment.

First aid

How to stop nosebleeds in a child? It is necessary to take actions that are aimed at an early stop of the symptom. Help with nosebleeds in a child should be provided immediately. Here is a brief action algorithm for parents:

1. To reassure the child, because the stress arising from the sight of blood is likely to cause an increase in blood pressure and heart rate, which will only increase bleeding. The child and others must be convinced that there is nothing terrible, there is no danger to life, and the bleeding itself will soon stop. Parents need to be calm and not to panic.
2. Set the child so that the back is straight, the head is slightly lowered down, and the body is slightly inclined forward. Then gently squeeze the wings of the baby’s nose with your fingertips, in other words, squeeze the nose. Stay in this position for at least ten minutes. You should not remove your fingers every thirty to fifty seconds, checking whether the blood is flowing or has already stopped.
3. During these ten minutes, while the parent holds the baby’s nose in place, something cold can be applied to the bridge of the nose. Suitable, for example, an ice cube, a spoon, a coin or frozen vegetables. It is helpful to give your child a drink or something cold (like ice cream, a glass of ice water through a tube), as the cold in the mouth will effectively stop nosebleeds.

Adult Mistakes in Assisting

How to stop nosebleeds in a child? Practice shows that most parents, faced with such a problem, get lost and make mistakes. These are exactly the mistakes adults can make by helping children with nosebleeds:

1. Do not throw your head back. In this case, the blood will not flow out of the nose outward, but flow inward along the posterior wall of the nasopharynx. So it becomes impossible to determine how intense the bleeding is, whether it has stopped or not, and the baby can suffocate if there is too much blood.
2. There is no need to stuff cotton wool, a corner of a handkerchief, a tampon or other “plugs” into the nose. So, instead of flowing out, the blood will infiltrate cotton wool, thicken, gradually dry up to the nose along with the “gag”. As soon as the parents pull out the cotton, bleeding can begin again.
3. Do not lay the child in a prone position. With severe bleeding, vomiting with an admixture of blood may begin, which in this position almost always leads to the fact that the child chokes. It is best, as mentioned above, to put the child on a chair or tilt his body slightly forward.
4. With severe bleeding from the nose, you do not need to provoke the child to talk or move. In most cases, this will only exacerbate the problem. But of course, it is necessary to calm the baby during first aid.

In which cases you need to call a doctor

Nasal bleeding in children is usually not a very serious and quickly fixable problem, but there are situations when the provision of qualified medical care is vital. This is true for the following circumstances:

1. Bleeding did not stop for twenty minutes. It is necessary to repeat the procedure for providing assistance (hold the nose wings with your fingers for another ten minutes). If after this the blood from the nose still flows, then it is urgent to call the doctors.
2. Intense bleeding from the nose, which occurs immediately from both nostrils. As a rule, this is caused by more serious causes than minor mechanical damage to the mucosa.
3. Epistaxis is aggravated by any other bleeding. If at the same time there is blood from the ear, for example, then you need to urgently call the doctors.
4. Bleeding from the nose is regular. If the problem repeats every day, once every two to three days, once a week, and the like, then you must necessarily show the child to a pediatrician.

With such nosebleeds in children, the need to visit a doctor is fully justified, since this symptom may indicate some kind of dangerous disease, and not just be the result of a bursting vessel.

An ambulance should also be called if the child is bleeding with an admixture of a clear liquid (especially after a head injury) or foams, he loses consciousness, and vomiting with an admixture of blood appears. The help of qualified doctors is necessary for bleeding in children with diabetes mellitus, hemophilia or other blood diseases, as well as if the problem arose while taking Ibuprofen, Indomethacin, Aspirin, Heparin and other similar drugs that worsen coagulation blood.

Coagulation of burst vessels with a laser or nitrogen

Nasal bleeding in children in a hospital is stopped by coagulation. Cauterization of a bursting vessel with a laser, electricity or liquid nitrogen is carried out if blood comes from the front of the nose. Indications for coagulation (electrocoagulation) are frequent bleeding, the ineffectiveness of trying to stop the blood in another way, very severe bleeding, as well as anemia due to relapse.

Treatment of bleeding from the back of the nose

Treatment of nosebleeds in children is also carried out with the use of hemostatic drugs. These methods are used if blood comes from the back of the nose. "Vikasol" or sodium ethamylate are prescribed. If the blood loss is plentiful, then solutions are injected intravenously, and, if necessary, donor blood components are transfused.

If there is a foreign object in the nose, then it is pulled out. In rare cases, it is necessary to use surgical methods, such as dressing or embolization of a bleeding vessel. The hospital also undergoes a full medical examination to determine the cause of bleeding.

Therapy and prevention of frequent nosebleeds

The causes and treatment of nosebleeds in children are interrelated. So, if the problem occurs often, doctors may suspect any disease associated with a violation of blood coagulation processes. In this case, you will need special treatment for the cause of the bleeding.

If the blood comes due to mechanical damage, that is, an injury or a foreign body enters the nose, then you need to act on the situation. Much depends on the severity of the injury (for example, a head injury that causes blood from the nose usually requires additional treatment). In case of damage caused by a minor mechanical force, there is no need to prescribe hemostatic drugs.

For therapeutic and prophylactic purposes, calcium preparations, retinol are prescribed, it is also vitamin A (used in the form of an oil solution for instillation into the nose), Ascorutin. For children with nosebleeds, the dosage of Ascorutin is shown as follows: one tablet three times a day. The course of therapy is ten days. Ascorutin is not prescribed for children with nosebleeds with the following diagnoses:

• diabetes;
• renal failure;
• urolithiasis disease;
• increased blood coagulation;
• individual sensitivity to the components of the drug;
• thrombophlebitis;
• fructose intolerance.

Some recipes of traditional medicine

There are several recipes for alternative medicine that can help reduce the frequency of nosebleeds in a child:

• to dig in the nose the juice of yarrow leaves;
• take half a glass of broth three times a day, the broth is prepared from two tablespoons of dry grass, pour half a liter of water, boil for ten minutes, and then insist for an hour;
• take one tablespoon of a decoction of viburnum bark three times a day, before meals, to prepare you need four tablespoons of crushed bark, pour one glass of water and boil for thirty minutes, and then strain and dilute with boiled water to the initial amount of liquid;
• drink a tablespoon of a nettle broth four times a day, the broth is prepared from a tablespoon of nettle leaves, which must be poured with a glass of water, boiled for ten minutes, and then cooled and filtered.

How to prevent nosebleeds

So that the problem does not recur, you need to walk with the child more often in the fresh air, play outdoor games, saturate the diet with fresh vegetables and fruits according to the season, and give the baby the vitamins prescribed by the doctor. As often as possible, moisten and ventilate the room in which the child is constantly located.