Nosebleed treatment with a bleeding disorder

Article Translations: (Spanish)

Nosebleeds are much more common in children than in adults. More than one of every four children will have a nosebleed at some time. Nosebleeds in children with a bleeding disorder may need special treatment.

What causes a nosebleed?

The nose is lined with arteries and veins that carry blood to the nose to help warm and moisten the air before it reaches the lungs. A thin membrane covers these blood vessels. In children this membrane is very fragile and can bleed easily.

Most nosebleeds occur in the front part of the nose, which contains the largest number of blood vessels.

Causes of a nosebleed include:

• allergies
• dry air and forced-air heating
• foreign objects in the nose
• high altitude
• nose surgery
• repeated use of medicated nose spray
• respiratory infection (cold)
• sinus infection
• trauma (bumping the nose)

What are the signs of a nosebleed?

• blood coming from inside the nose, either alone or with mucus
• bloody vomit
• black, bloody, or tar-like bowel movements

How should I care for my child?

1. Stay calm and reassure your child.
2. Have your child sit up and lean forward.
3. Firmly press the soft sides of your child's nose together for 10 minutes. Do not stop. Encourage your child to breathe through the mouth.
4. After 10 minutes, check to see if bleeding has stopped. If not, press the nose again for 10 more minutes.
5. It may help to put ice or a cold compress over the bridge of the nose or the
   sinuses.
6. Use medicines if prescribed by your hematologist.

When should I call the clinic?

Call the clinic if:

• the bleeding does not stop after the above measures have been tried for 20 minutes.
• you think the nose is broken.
• a foreign object is in the nose.
• black, bloody, or tar-like stools.
• bloody vomit.

Your health care provider may prescribe factor concentrate, Amicar®, Nosebleed QR®, or DDAVP.

What else do I need to know?

For 24 hours after a nosebleed, avoid:

• blowing the nose.
• picking the nose.
• rubbing the nose.
• lifting heavy objects.
• active exercise.
• hanging upside down.

It takes 7 to10 days for the nose to heal after a nosebleed stops. During this time be careful about rubbing and blowing the nose.

Keep the nose moist with:

• saline nose spray.
• vaporizer at the bedside.
• KY Jelly® or antibiotic ointment – apply a small amount inside the nostril opening with a cotton swab.

Questions?

This sheet is not specific to your child, but provides general information. If you have any questions, please call your clinic. For more information about bleeding disorders the following Web sites are available:

• www.cdc.gov
• www.hemophilia.org

Children's Hospitals and Clinics of Minnesota
Last reviewed by Hematology 8/2015

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