Nosebleeds in Children — Why They Happen and What to Do

Why does a child's nose bleed

Epistaxis (nosebleed) is extremely common in children, especially between 2 and 10 years of age. In the vast majority of cases — over 90% — the bleeding originates from the anterior area of the nasal septum, a zone called the Kiesselbach plexus, where several fine blood vessels meet very close to the mucosal surface.

In children, the nasal mucosa is thinner and more fragile than in adults, which makes blood vessels more prone to rupture.

Common causes of epistaxis in children

Local causes

• Nose picking — the most common cause, especially in young children who insert their fingers into their nose
• Dry air — during the cold season, radiators dry out the air in the room, and the nasal mucosa becomes dehydrated and cracks
• Respiratory infections — rhinopharyngitis causes inflammation of the mucosa, making it more vulnerable
• Allergic rhinitis — chronic inflammation and repeated sneezing weaken the mucosa
• Trauma — blows to the nose during play or sports activities
• Foreign bodies — an object inserted into the nose can erode the mucosa and cause bleeding, usually unilateral and with an unpleasant smell
• Blowing the nose too hard — creates excessive pressure on the fine vessels of the septum

Less common causes

• Nasal septal deviation
• Coagulation disorders (rare, but important to rule out in cases of repeated or difficult-to-stop bleeding)
• Prolonged use of nasal corticosteroid sprays (can thin the mucosa)

First aid — How to correctly stop the bleeding

When a child has a nosebleed, the most important thing is to remain calm and act correctly:

What you should do

• Sit the child upright, with the head slightly tilted forward (not backward!)
• Compress both nasal wings between the thumb and index finger, on the soft part of the nose, below the nasal bone
• Maintain constant compression for 10 minutes — time it, do not check earlier
• The child should breathe through their mouth during this time
• You can apply a cold towel or ice pack to the bridge of the nose (but direct compression is most important)
• If the bleeding has not stopped after 10 minutes, repeat compression for another 10 minutes

What you should NOT do

• Do not tilt the child's head backward — blood will flow down the throat and be swallowed, potentially causing nausea or vomiting
• Do not insert cotton or packing into the nose without medical recommendation — removal can trigger a new bleed
• Do not have the child lie down during the bleeding
• Do not let the child blow their nose immediately after the bleeding stops — wait at least a few hours

The golden rule: head tilted slightly forward, firm compression on both nasal wings for 10 minutes without a break. This simple manoeuvre stops the vast majority of nosebleeds in children.

How to prevent recurrent nosebleeds

• Moisturise the nasal mucosa — apply a few drops of physiological saline or a hydrating nasal gel daily, especially during the cold season. Regular nasal hygiene keeps the mucosa healthy.
• Humidify the air in the room — use a humidifier especially during winter
• Keep the child's nails short — reduces trauma caused by nose picking
• Treat underlying causes — allergic rhinitis or recurrent infections should be managed appropriately
• Avoid aspirin and ibuprofen during periods of frequent bleeding (these medications affect coagulation)

When you should see a doctor

Most nosebleeds in children are benign and stop on their own with correct compression. However, consult a doctor if:

• The bleeding does not stop after 20 minutes of correct compression
• The bleeding is heavy or occurs after significant facial trauma
• The child has frequent epistaxis (more than once a week)
• Bleeding occurs from both nostrils simultaneously and is difficult to control
• The child also has other signs of bleeding: easy bruising, gum bleeding, petechiae (red spots on the skin)
• The child takes anticoagulant medication or has a family history of coagulation disorders

The ENT specialist can perform a nasal endoscopy to identify the exact source of bleeding. In cases of recurrent anterior bleeding, chemical cauterisation (with silver nitrate) may be performed — a simple, quick, and effective procedure done on an outpatient basis.

Conclusion

Nosebleeds in children are generally a minor problem, but they must be managed correctly. Nasal compression for 10 minutes with the head slightly tilted forward stops most episodes. Prevention through moisturising the mucosa and managing underlying causes significantly reduces the frequency of episodes. If nosebleeds are frequent or difficult to stop, consultation with an ENT specialist is recommended.