How to Prevent and Stop a Nosebleed

What is a nosebleed?

A nosebleed, or epistaxis, is when blood comes from your nose. It happens when tiny blood vessels inside the nose break and bleed. There are 2 types of nosebleeds:

• Anterior nosebleeds start in the front of the nose. Blood leaks into the nasal cavity (the space inside your nose) and out of the nostrils (the 2 openings at the end of your nose that you breathe through). This is the most common kind of nosebleed. It usually can be cared for at home.
• Posterior nosebleeds begin deeper in the nose, close to the throat. These are rare but can lead to heavier bleeding and may need medical care.  

Causes of nosebleeds

There are many reasons why a nose might start to bleed. Some are common and can happen as part of daily life. These include:

• Dry air
• Blowing your nose too hard or too much 
• Sneezing
• Picking your nose
• Injury
• Irritants (such as smoke or cleaning products)
• Low platelet counts (thrombocytopenia)
• Inherited bleeding problems

Risk factors for nosebleeds

Some people get nosebleeds more often than others. Knowing what causes nosebleeds can help you prepare for and prevent them. 

Factors that may increase the risk for nosebleeds include:

• Blood disorders or conditions that decrease the blood's ability to clot  
• Family history or inherited traits that make the blood vessels more likely to bleed 
• Medicines, such as blood thinners or some nasal sprays
• High blood pressure 
• Surgery on or near the nose 
• Lifestyle choices such as smoking, drinking too much alcohol, or using certain drugs  
• Deviated septum or change in nose structure that causes dryness
• Allergies or infections that irritate the nose
• Climate factors such as high altitude, low humidity, or wind

Treatment of a nosebleed

Take simple steps to help stop bleeding:

• Have your child sit up and lean forward slightly. This helps keep blood from going down the throat. Do not lie down or tilt the head back. 
• Pinch the outside of the nostrils. Use your thumb and finger to squeeze the soft part of the nose. Have your child breathe through their mouth. Keep gentle pressure for about 10 minutes. A nose clamp can also be used to hold the nostrils closed. Release pressure slowly to see if the bleeding has stopped.
• Use a cold pack. Put an ice pack or cold cloth on the nose and cheeks to slow the bleeding. Reusuable ice packs specially shaped for the nose are available.

Care after a nosebleed

After a nosebleed, your child's nose may take several days or longer to fully heal. After a nosebleed, take steps to prevent additional bleeding:

• Rest and avoid running or rough play until you are sure the bleeding has stopped.
• Do not pick, rub, or blow your nose hard. 
• Do not strain with bowel movements (pooping).
• Do bend down or lift anything heavy.
• Keep the nose moist. Use saline spray or gel to stop it from drying out.
• Stay away from hot drinks, hot showers, and straws for at least 24 hours. 
• Use a humidifier to keep the air moist.

Medical care for frequent or severe nosebleeds

If your child keeps having nosebleeds, your doctor may suggest other treatments. These may include:

• Nasal packing: Special material may be put in the nose to stop bleeding that will not stop on its own.
• Sealing the blood vessels: A doctor can use a chemical or heat to seal (cauterize) the tiny blood vessels in the nose to help prevent nosebleeds.
• Medication: Your health care provider may suggest medicine changes or prescribe medicines to help with nosebleeds. Medicines to help treat nosebleeds include:
  • Aminocaproic acid (Amicar®) helps slow the breakdown of blood clots
  • Tranexamic acid (Lysteda®) helps slow the breakdown of blood clots
  • Desmopressin acetate (DDAVP, Stimate®) increases clotting factors and helps blood to clot
  • Afrin nasal spray constricts blood vessels in the nose to help stop bleeding 
• Treating underlying health problems: Taking care of issues like bleeding disorders, high blood pressure, or sinus infections can help prevent nosebleeds.

When to contact your care team

Sometimes, swallowing blood during a nosebleed can cause stomach upset and vomiting. You might also see dark, sticky stools (poop) later. This is usually normal after a nosebleed. 

Seek medical care if your child:

• Has a nosebleed that lasts longer than 20 minutes
• Loses a lot of blood (more than 1 cup)
• Throws up blood or something that looks like coffee grounds
• Has trouble breathing
• Is dizzy or loses consciousness

How to prevent nosebleeds

Ways to lower the risk of nosebleeds include:

• Manage health problems. Get checkups, especially if your child has many nosebleeds or an underlying health condition. Know risk factors such as medications, high blood pressure, and allergies. 
• Keep the inside of the nose moist. Use saline spray or gel. You can also put petroleum jelly inside the nose. Wear a scarf over the nose to protect against cold, dry, or dusty air. Use a humidifier to keep the air moist. 
• Avoid nosebleed triggers: Avoid cigarette smoke, chemicals, or other things that irritate the lining of the nose.  
• Prevent injuries to the nose. Be careful during sports and activities and wear safety gear. Keep your child's fingernails short. Remind your child not to rub or blow their nose too hard or too often and avoid bending over for long periods of time.  
• Eat healthy. Certain vitamins and minerals are needed for healthy blood cells and blood vessels. Foods that may lower the risk of nosebleeds include: 
  • Iron-rich foods, such as spinach, legumes, and red meats  
  • Foods high in vitamin C, such as citrus fruits and berries  
  • Foods high in vitamin K, such as leafy greens 

Questions to ask your care team

• What can I do to help prevent nosebleeds?
• Is my child at higher risk for nosebleeds?
• Are there special steps I should follow if my child has a bleeding disorder or takes blood thinners?
• What treatments are available if nosebleeds keep happening or are hard to stop? 
• How can I treat nosebleeds at home?
• What should I tell my child’s teacher or others about how to manage nosebleeds if they happen at school or during activities?
• When should I call the doctor or go to the emergency room for a nosebleed?

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