Stop nosebleeds, but do it right

Jannis is still picking his nose, lost in thought, and then it happens: Suddenly, blood runs out of his right nostril and drips uncontrollably onto his clothes - panic ensues. What looks dramatic at first glance is actually completely harmless in most cases. Lorraine de Trey, a specialist at the Milchbuck ENT practice in Zurich, knows what causes nosebleeds and what to do.

Nosebleeds mainly affect children between the ages of three and five, but older children also suffer from them.

Lorraine de Trey, doctor

«Around 60 per cent of all children over the age of two experience nosebleeds at some point. It most frequently affects children between the ages of three and five, but older children also suffer from it in some cases,» says de Trey. It is much less common in children under two and older teenagers.

The cause of epistaxis, the medical term for nosebleeds, often lies in the sensitive vessels in the front part of the nasal septum. These can start to bleed quickly due to their superficial location. Blowing your nose hard, intense nose picking or a bruise from a ball are often enough to trigger the bleeding.

Children naturally panic at that moment - especially when they see their own blood for the first time. Even if it is also a shock for the parents at first when the child comes running in covered in blood and crying, they should keep a cool head and provide distraction. Talk the child down and explain that nothing bad is happening to them right now. Or trying to divert their attention to something else can help, as violent crying makes all other measures more difficult.

Put your head back? Better not!

Incidentally, the first reaction to a nosebleed is the wrong one: to lean your head back so that it stops dripping. This is not a good idea. The blood finds another route and runs down the throat instead of out of the nose. This can cause nausea and vomiting if a certain amount is ingested. Neither of these are useful in an already stressful situation.

«It's best to sit upright with your head bent forwards and let the blood flow into a bowl or sink,» says the ENT specialist. Blood that has got into the mouth should be spat out to avoid nausea. A cold cloth on the back of the neck or a cooling pad wrapped in a towel will constrict the blood vessels. It helps to stop the bleeding.

If the bleeding cannot be stopped despite all measures, you should go to an emergency ward.

Lorraine de Trey, doctor

Now such incidents often happen outside, where you don't necessarily have cold water or a cooling pad to hand. In this case, de Trey advises: «Compress the nose with your thumb and index finger over the nostril for around 10 to 15 minutes and breathe calmly through your mouth. Don't keep checking to see if it's still bleeding, but compress continuously.» In this way, almost every anterior nosebleed can be stopped. After that, take it easy. Blowing your nose and picking your nose are taboo for the next 48 hours, otherwise the whole thing can start all over again.

A common remedy is to stick a piece of tissue or cotton wool up your nose to stop the bleeding. This does fulfil its purpose at first. However, it can cause the fresh wound to open up again as soon as the tissue or cotton wool is removed. It is therefore better to use the compression technique. After around 10 to 15 minutes, the bleeding should stop and the shock should soon be forgotten.

When the whole thing still needs to be looked at more closely

«If the bleeding continues despite all measures, you should go to an emergency centre,» advises de Trey. Occasional nosebleeds are no cause for concern. In some cases, however, it is advisable to consult an otorhinolaryngologist (ORL), a specialist in ear, nose and throat diseases. For example, if nosebleeds occur repeatedly over several weeks and severely affect the child's everyday life at school, in leisure time or during sport.

«Cases in which the blood does not flow out of the front of the nose, but mainly runs down the back of the throat, even though the child is sitting upright, should also be clarified,» says the doctor. If bleeding always comes from the same side and this side is also blocked so that the child can no longer breathe well, a visit to a specialist is also indicated.

«However, a nosebleed alone without any other symptoms is no cause for concern,» says de Trey, giving the all-clear. The frequency or severity of nosebleeds does not say anything about the cause. Even blood clots, known as clots, are not alarming, but a natural reaction of the body.

How nosebleeds can be prevented

Such incidents happen from time to time, especially in winter, when colds put more strain on the nose and the sensitive mucous membranes are additionally dried out by the heating air. It is therefore recommended that rooms are regularly ventilated in winter and that humidifiers are installed if necessary.

Inexpensive alternatives: hang damp towels around the home or place a bowl of water on the radiator and top it up as soon as the water has evaporated. As a preventative measure, it also helps to use a nasal ointment to keep the nasal mucous membranes moist and prevent cracks from forming. To minimise the risk of injury when picking the nose, children's nails should also always be cut short.

If nothing helps: cauterisation with silver nitrate

If an injured vessel in the front of the nose is identified as the cause of the frequent nosebleeds, the specialists often resort to cauterisation with silver nitrate. «With this method, the exact location of the bleeding is first localised and then locally anaesthetised. The affected vessel is then cauterised with a silver nitrate stick,» explains Séverine Niederer-Wüst. She is a consultant at the Children's Hospital of Eastern Switzerland and runs an ENT practice in Gossau SG.

Treatment with silver nitrate is a routine procedure and is considered an effective method for nosebleeds. Overall, the procedure only takes a few minutes - the part with the silver nitrate only a few seconds. After that, nosebleeds should generally no longer cause any problems.

«The procedure can usually be carried out in the ENT practice. Only if the child is still too small or doesn't want to participate is the procedure performed under general anaesthetic in hospital,» says the specialist. In this case, the vessel can also be treated with bipolar forceps. This works with electricity and precisely cauterises the affected area. Although treatment with bipolar forceps can also be carried out under local anaesthetic, it is particularly unpleasant for young children.

In rare cases there is another cause

«In rare cases, such as when the larger vessels in the posterior or upper nasal area are affected and the blood loss is significant, the vessel must be closed in an operation,» Niederer-Wüst reports of very special exceptions. However, this is more common in adults than in small children.

Frequent nosebleeds can also be an indication of a blood clotting disorder. «However, this is often accompanied by other symptoms. For example, children bruise very easily or often have bleeding gums,» says the doctor, explaining the signs. In this case, treatment is not surgical, but medical and falls under the remit of haematologists.