Nosebleeds in children

introduction

Nosebleed (lat .: Epistaxis) in children can often be observed. When blood suddenly drips from the nose and does not seem to want to stop, the fear and dismay is not only great among the children concerned.
In most cases, however, the concern is unfounded and the nosebleed appears much more dramatic than it actually is. Even without external intervention, the blood flow usually dries up on its own. Medical intervention is only necessary in a few cases.
Instead, depending on the possible causes, simple steps can stop your child's nose bleeding. Unfortunately, even today, there are often large gaps in knowledge about suitable first aid measures.

What happens with a nosebleed?

Our nose is used by many small blood vessels provided. In the area of ​​the anterior nasal septum, these vessels form numerous connections with one another, so that a dense network, the so-called "Locus Kiesselbachi", Arises.
Since the fine blood vessels sit close to the surface of the thin septum, they can be proportionate easily injured and so cause the typical nosebleed. Other blood vessels, on the other hand, rarely cause bleeding from the nose ("posterior nosebleed").

causes

There are many causes of sudden nosebleeds. In the vast majority of cases, children have in the Nose drilled or scratched the inner lining of the nose, which can lead to bleeding from the nose. Blood clotting continues in healthy children few minutes and so the bleeding usually stops very quickly. In other cases one has a Slap on the nose or a fall Contributed to bursting a blood vessel in your nose and starting to bleed. Furthermore, there are some causes of nosebleeds that are not immediately apparent. Chronic dryness of the nose can lead to the so-called Locus Kiesselbachi bursting open and bleeding profusely.

Changes in blood countwhich lead to a reduction in important blood platelets, can also lead to a nosebleed, which is very difficult to stop. The clotting is due to the reduced number of platelets prolonged, the bleeding is usually heavier and difficult to stop. For this reason, young children with recurrent nosebleeds should always be aware of a serious disease of the blood system.
The increase in pressure in the blood vessels in the nose and mucous membrane is much more harmless than the cause and is relatively common. So can be a violent and strong blowing of the nose always lead to a nosebleed. Even if the child is going through a severe cold season, it can happen that through frequent blowing your nose the mucous membranes are so irritated that it quickly leads to a nosebleed.

In many cases, unfortunately, no clear explanations for nosebleeds can be found. However, the following causes can often play a role:

Nosebleed with cold and runny nose

The nasal mucosa is particularly stressed in the case of a cold and cold. Children in particular suffer from recurring colds, as they can easily get infected with their playmates.

Frequent nose blowing and strong blowing of the nose can temporarily damage the blood vessels within our olfactory organ. Injured or burst veins lead to nosebleeds. The shock is often great when the child's handkerchief suddenly turns red!
However, injured vessels in the nasal mucosa usually heal quickly on their own. Frequent and strong blowing your nose and blowing your nose, not least due to the constant increase in pressure in the nasal area, mean that blood vessels become more porous and can tear more easily. If you have a long cold, nasal ointments or nasal oils are very helpful. They are entered into the front part of the nose and care for the nasal mucous membranes. This leads to the fact that the mucous membrane becomes more supple, the blood vessels do not become porous and start to bleed as quickly and the dryness of the entire nasal cavity is reduced.
Particular caution is required when using decongestant nasal sprays: If your child's nose is blocked, decongestant nasal drops ensure quick breathing due to their vasoconstricting effect.
However, when used over a long period of time, they dry out the sensitive nasal mucosa and can cause nosebleeds.

Read more about this under Nasal sprays for nosebleeds and Nasic® nasal spray for children.

Epistaxis from dry air

It dries in winter warm heating air our mucous membranes off. Small children in particular, who spend almost all of their time in heated rooms during the cold season, are at risk. The dried out nasal mucous membrane also damages the vessels lying just below the surface and this can lead to nosebleeds.

You can also find more information here: Epistaxis in young children

Nosebleed after a fall

After a Fall on the face your child's nose can be affected. Often the force of the impact alone is enough to trigger a nosebleed.
At a bony injury, such as. one Broken nose, in addition to sometimes severe nosebleeds, swellings and "bruises" (lat .: Hematomas) observe. However, a simple bruise of the nasal bone is often enough to cause bleeding.
So it can happen that a fall can result in a heavy nosebleed, possibly with a so-called Tamponade needs to be treated. A tamponade is one Compression of the vessels by gauze materialthat is inserted into your nose to stop the bleeding. If this does not work, the nose should also be examined more closely to find out exactly which sections of the nose have been injured.

The nosebleeds can be particularly severe if there are tears in the nasal mucous membrane that is well supplied with blood. Also Sports accidents or small scuffles can lead to nosebleeds in children.

Nosebleeds from foreign bodies and manipulation

Occasionally, parents and their children go to the pediatrician because small items, such as. Lego bricks or peas when playing mistakenly in the nose have arrived. There they can cause injuries or cracks and thus nosebleeds.
At sudden nosebleedsTherefore, you should always keep this possibility in mind, especially when playing with the corresponding objects.

Furthermore, small children in particular often pick their noses. Through this manipulation, the children can accidentally minimal mucosal injuries trigger, which lead to nosebleeds.

Nocturnal nosebleeds in children

If children suffer from nosebleeds unnoticed at night, they are terrified the next morning: pillows smeared with blood or a bloody face are not uncommon.
But again: it almost always looks worse than it is! Because warm heating air dries out the children's mucous membranes while they sleep.

In many cases, the child has their nose in it scratched or drilled in it with your finger. The night nosebleeds can be just like the nosebleeds during the day cooling compresses on the neck be treated. Furthermore, the nostrils should be squeezed together. It is also important to wake up the child and get them into the seat. Nosebleeds while lying down always carries the risk that Blood in the throat and stomach running and that it causes nausea or the child breathing in the blood.

This can cause night nosebleeds, especially in the cold season. Also as part of a Upper respiratory tract infection the phenomenon can occasionally be observed. However, if your child does very often with recurring, violent nosebleeds suffers at night, consider yours See a pediatrician. Behind it can also e.g. Hide defects of the nasal septum or coagulation disorders. With harmless causes you can nourishing nasal ointments are given in the front part of the nose, which should make the skin more supple and prevent it from drying out.

Nosebleed from excitement

When small children are upset, nosebleeds can occur from time to time. The background is that when excited, both the child's and the child's pulse Blood pressure rise As a result, blood vessels in the nose that have already been damaged may burst open and bleed. The most important measure is next to that Neck cooling is also calming of the child. By persuading the patient calmly, the blood pressure is lowered and the blood clotting in the nose can occur more quickly. Further measures are usually no longer necessary.

You can also find more information here: Epistaxis during stress

Rare causes of nosebleeds in children

In the vast majority of cases, nosebleeds in children are a problem harmless explanation underlying. In the case of recurring, difficult-to-stop events, a cause outside the nose should also be considered.

But also a congenital platelet defect (lat .: Platelets) or blood clotting chain, can in very rare cases cause nosebleeds in children. Various, extremely rare syndromes (such as Rendu-Osler's disease) should continue to be observed in the case of recurring, severe episodes.
If especially Boys from the age of 10 suffer from severe nosebleeds, a benign tumor of the nasopharynx (lat .: juvenile nasopharyngeal fibroma) to be available. In addition to the described nosebleeds, affected children often suffer from nasal breathing difficulties, headaches and persistent runny nose.

For general information read more under Causes of nosebleeds

Epistaxis in leukemia

Unfortunately, nosebleeds can also have a very serious, but luckily, rare cause. It should be examined and ruled out particularly if nosebleeds in young children again and again occurs. leukemia (Blood cancer) is a malignant disease of the blood-forming system. An infestation causes certain blood cells to grow not yet fully trained and are not operational, are washed out into the bloodstream. However, since the cells are not yet mature, they cannot do the job like healthy blood cells. If platelets are also affected, the number of platelets decreases, which ensures that the Blood clotting takes longer and that it bleeding very quickly comes. Next Bleeding gums and Blood in the urine children with leukemia are also repeatedly affected by a recurring nosebleeds noticeable. The diagnosis is made by means of a blood test or a bone marrow puncture. Leukemia is relatively common in infancy, but is usually easy to treat. Chemotherapy, radiation and, if necessary, a bone marrow transplant are used depending on the type of disease. The prognosis for treatment can be good depending on the type of leukemia and the stage of the disease.

You can find more information on this topic here: Leukemia in children

Epistaxis for no reason

In many cases a nosebleed occurs for no apparent reason on. High blood pressure is extremely rare in children and is usually excluded as a cause. If children do not manipulate the nose and no fall can be remembered, the most common cause of nosebleeds is a porous plexus of veins in the anterior turbinate. Often times, nosebleeds go away very quickly and no longer occurs. The exact cause then usually remains in the dark.

Symptoms

Nosebleeds can either occur completely alone or have been associated with other symptoms. If it is e.g. If the bleeding is very heavy, in which the child loses a lot of blood, it can lead to an accompanying deterioration in general condition. Very rarely, however, is the blood loss so high that it becomes significant Anemia comes.
Nosebleeds and accompanying headache can speak for an infection or high blood pressure, among other things.

Nosebleeds and the parallel blood clotting in the nose almost always leads to one Impairment of breathing through the nosecausing children to breathe in and out through their mouths after a severe nosebleed. It is important to have a moisturizing treatment for the nasal mucous membranes Nasal ointment. Young children in particular become restless when they have nosebleeds and begin to scream, which makes it even more difficult for parents or the doctor to treat them quickly.

diagnosis

The diagnosis of nosebleed in children is a visual diagnosis, as blood usually flows uncontrollably from the anterior turbinate. After the initial measures are taken immediately, the bleeding usually stops. If you had a single nosebleed, you would no further action initiate.
However, if nosebleeds keep recurring in small children, the exact cause should be investigated. For this purpose, the anterior turbinate and the nasal passage mirrored by the pediatrician or the ENT doctor and viewed with a bright light. So he can e.g. View and assess porous blood vessels (e.g. Locus Kiesselbachi). Furthermore, if the nosebleed recurs, the Blood pressure of the child can be measured in order not to overlook high blood pressure as the cause. In addition, a blood test should be carried out, which can give evidence of a platelet disorder or leukemia, which also often leads to nosebleeds that are difficult to stop or that recur.

Normally, nosebleeds do not have to be elaborately clarified or diagnosed by medical examinations. If parents with their child nevertheless e.g. Consult the ENT doctor, this can be possible through various methods Identify sources of bleeding.

The examination may be possible for children unpleasant This is why topical anesthetic nasal sprays are often used. Supplementary examinations are very rarely necessary. Possible procedures can be the middle and posterior nasoscopy, Ultrasonic, Nasal endoscopy, CT or MRI.
If an underlying disease is suspected, your pediatrician will also conduct further examinations, such as Blood draws, a.

therapy

Although nosebleeds are quite common, many parents and children do not know what to do at first. Unfortunately, there are still some fundamentally misconceptions about how to best stop the nosebleed. So what should you do?

• Keep calm - even if it looks dramatic, nosebleeds are almost always harmless! Soothe and comfort your excited child
• Bend your child's head slightly forward, possibly over a drain. Also, make sure that your upper body is upright, and under no circumstances should your child tilt their head if they experience a nosebleed. This method, which used to be common in the past, is now out of date, as this measure causes the blood to flow into the throat and stomach, which a short time later causes nausea.
• Any blood in the mouth should be spat out to prevent nausea and vomiting
• Use your thumb and forefinger to press the nostrils firmly together for 10-15 minutes
• Cold compresses or compresses on the neck can have a supportive effect

There is also the possibility of inserting hemostatic cotton wool into the turbinates. This coated cotton wool also accelerates blood clotting. It is important to ensure that the cotton is not pushed too deep into the nose so that it can be pulled out again later! If these measures do not help to stop the nasal bleeding, you should urgently consult a pediatrician who will examine the nose in more detail.

Read more on the topic: What to do if you have a nosebleed? Homeopathy for nosebleeds

Therapy for recurrent nosebleeds

Recurrent or particularly heavy nosebleeds in children may require causal therapy. Once the source of the bleeding is identified, there are several ways to stop it.

• Nasal ointment
  • Mild forms can be treated with generous use of nasal ointment. With the help of cotton wool, the nourishing ointment can easily be inserted into the nose. Dry nasal mucosa is soothed and heals faster.

• Desolation
  • To avoid recurring bleeding, the affected blood vessels in the nasal mucosa can be "closed". Under local anesthesia, either with the help of electricity ("Electrocoagulation ") or chemical substances can be worked quickly and effectively.
  • The procedure is uncomfortable for children, but not painful. Nowadays, doctors mostly use electrocoagulation.
  • Read more on the topic: Sclerosing with nosebleeds
• Lasers
  • The most modern method for preventing nosebleeds is laser therapy. Currently it is mainly used in severe cases or unsuccessful attempts at sclerotherapy.

When does my child need a doctor?

As a rule, children do not need medical attention if they have nosebleeds. Certain situations may make this necessary in rare cases:

• Symptoms of a greater blood loss, such as. Weakness, paleness, or loss of consciousness

• Recurring nosebleeds

• concomitant symptoms of platelet deficiency, such as "bruises" that develop very quickly or excessive bleeding from small injuries

• Epistaxis Fracture of the nasal bone (Swelling and bruises on the face?)

forecast

The prognosis for childhood nosebleeds is extraordinary good. Larger, life-threatening blood losses practically never occur. New therapy options, such as laser treatments, can also eliminate stubborn nosebleeds.

prophylaxis

Dry nasal mucosa cannot adequately protect the delicate blood vessels in our olfactory organ, so nosebleeds are more likely.
So pay attention to sufficient humidity in the nursery. It is enough to put a damp towel on the warm heater. To support, can Seawater nasal sprays or caring Nasal ointments (e.g. with Dexpanthenol) be applied.

For more information on drugs containing dexpanthenol, see Bepanthen®

If your child has a cold, you should only Be extremely careful with decongestant nasal sprays and use them for a few days if possible. To promote the healing process, you can also use Nasal irrigation or Inhalations to be thought about. In summary, nosebleeds cannot always be avoided in children, but the mentioned measures can reduce the risk.