Nosebleeds in Children: What to Do, and What to Forget

In the middle of a game, or on waking with a red stain on the pillow: your child's nose is bleeding, they are scared, and the blood looks plentiful. A child's nosebleed (doctors call it epistaxis) is very impressive, but it is almost always harmless and stops with a simple action, provided it is done correctly.

That is where the problem lies: the reflex handed down from generation to generation, head back, is exactly the one to avoid. Here is the right technique, the common mistakes, the causes and the situations where you should see a doctor or call 141.

Why do children's noses bleed so easily?

Because the front of the nose is lined with tiny, very fragile blood vessels, just under the surface. A slightly dry lining, a fingernail, blowing too hard, and the vessel gives way. The British NHS counts children among the people most prone to nosebleeds.

The most common causes:

• fingers in the nose, or a small object pushed into a nostril;
• a cold, which irritates the lining and means frequent nose blowing;
• dry air, winter heating or the chergui (the hot, dry Moroccan desert wind), and changes in temperature;
• sun and heat, mentioned by Santé.fr;
• a knock to the nose, while playing or falling;
• an allergy that causes sneezing and nose rubbing.

Very often, especially in children, no precise cause is found.

The right technique, step by step

All the sources we consulted, from Quebec to Geneva, describe the same action.

1. Reassure your child and stay calm: a calm child is easier to help.
2. Sit them down, head slightly tilted forward, over a sink or a towel, mouth open. The blood runs out instead of down the throat.
3. If they can, have them blow their nose once before pinching, to clear out clots. Before age 2 this is rarely possible: go straight to the next step.
4. Pinch the wings of the nose, the soft part just below the bone, between thumb and index finger. This is the area that bleeds most often.
5. Keep up the pressure for 10 minutes without letting go, while they breathe through the mouth. Watch the clock: 10 minutes is long, and the temptation to check every two minutes makes the bleeding start again.
6. Release gently. If it is still bleeding, have them blow to remove the clot and pinch again.

A cold pack wrapped in a cloth on the top of the nose or the forehead may help, but the NHS notes that the evidence is weak: it is a supplement, not the main action.

Mistakes to avoid

Tilting the head back. This is the most widespread reflex, and the worst. The bleeding does not stop: the blood runs down the throat, your child swallows it, coughs or vomits, and you can no longer see whether it is still bleeding.

Lying your child down. The Geneva school health service explicitly forbids it, and the NHS advises avoiding lying flat for the following 24 hours.

Letting go too early to "see if it is still bleeding". Every peek breaks up the clot that is forming.

Pinching the top of the nose, on the bone: the pressure does not reach the area that is bleeding.

Pushing in a piece of cotton or a rolled tissue into the nostril. None of the parent leaflets we consulted suggests it. The Geneva leaflet only mentions a haemostatic wick, a specific product, placed under supervision by trained staff.

Having your child blow their nose during the pinching, or hard just afterwards.

After the bleeding: precautions for the following hours

Once the bleeding has stopped, the clot stays fragile. For a few hours, and ideally until the next day:

• no vigorous nose blowing, no fingers in the nose, no scab picking;
• no strenuous effort or rough play; Geneva advises at least an hour of calm;
• no very hot drinks straight away;
• no lying flat, according to the NHS.

If it starts again, pinch again. If the bleeding does not stop on the second attempt, see a doctor.

Frequent nosebleeds: how can you prevent them?

When the nose bleeds often, the cause is most often local and prevention comes down to a few habits:

• cut nails short and help your child lose the habit of picking their nose; nail scissors made for children make the job easier;
• keep the lining moist: a well-maintained humidifier in the bedroom when the air is dry, and saline washes during colds, as explained in our guide to nasal washing;
• teach gentle nose blowing, one nostril at a time;
• treat an allergy that makes your child rub their nose all the time (see allergic rhinitis in children);
• protect from sun and heat in summer.

If the nosebleeds keep coming back despite everything, talk to the doctor. They will check inside the nose and, if needed, order a blood test to look for a clotting disorder or anaemia, especially if your child is pale and tired. An ENT specialist can sometimes cauterise the vessel responsible.

Nosebleed after a fall or a knock

After a blow to the nose, pinching remains the first action. But a nosebleed that follows a fall on the head or face always calls for medical advice, to check the nose and the rest. Also watch for the neurological signs described in our article on a baby who fell on their head. And if you want to be ready for all these situations, our guide to first aid for children covers the essential actions.