Nosebleeds in Young Children. What Every Parent Should Know
Nosebleeds occurs commonly in children, especially in those between the ages of 2 and 10 years old. In most cases, nosebleeds are secondary to local trauma and can be cared for primary care physicians. In rare instances, however, a nosebleed may be difficult to control or may be a manifestation of a serious systemic illness.
Referral to an otorynolaryngologist or hematologist/oncologist is usually not required except in these situations, and hospitalization is generally unnecessary. Parents and children, who are often frightened by nosebleeds, frequently overestimate the amount of blood lost.
Understanding and reassurance are important in dealing with anxiety. Thirty percent of children have one nosebleed by the time they are 5 years of age. In children between 6 and 10 years old, frequency increases to 56%. Nosebleeds are rare in infancy and infrequent after puberty. They occur much more frequently in the late fall and winter months, when URIs are common, environmental humidity is relatively low, and the use of heating systems results in dryness. Nosebleeds are also more common in children who live in dry climates, especially if they have an upper respiratory infection or allergic sinusitis.
Possible Causes to Rule Out
- Inflammation of the nasal mucosa from a upper respiratory infection are by far the most common causes of nosebleeds in children.
- Repetitive habitual nose picking.
- Viral respiratory infections, such as measles, infectious mononucleosis, and influenza, may also predispose children to nosebleeds.
- Although nosebleeds are usually benign conditions, they may be the first sign of serious illness. Persistent or recurrent nosebleeds with no obvious cause should raise the suspicion of bleeding disorders.
- Thrombocytopenia is the most common condition causing nosebleeds.
- Leukemia and HIV must be strongly considered and ruled out in children with nosebleeds and thrombocytopenia.
- The most common inherited bleeding disorder associated with nosebleeds is von Willebrand's disease.
- Hemophilia and Glanzmann's thrombastenia are other inherited bleeding disorders that may lead to nosebleeds.
- Liver disease, severe vitamin K deficiency, or malabsortion syndrome may be associated with nosebleeds.
- Nosebleeds may be a manifestation of blood vessel disorders.
- Vitamin C deficiency is associated with nosebleeds.
- Neoplasms (tumors), particularly malignancies, are uncommon causes of nosebleeds in children.
- Drugs such as aspirin and NSAIDs increase the risk of nasal hemorrhage with minor trauma, infection, or inflammation.
- Cocaine snorting may cause nasal septal perforation and nosebleeds.
Recommended Lab Tests Lab tests are rarely indicated in most children with nosebleeds. Hemoglobin and Hematocrit should be obtained. In the event, your child continues to have nosebleeds, a complete examination should be performed to rule out any of the conditions listed above.