Epistaxis (Nosebleeds)

02/2021 Epistaxis (Nosebleeds) Page 1 of 2

Epistaxis (Nosebleeds)

PATIENT EDUCATION

Definition:

• Althoughtheycanbescary,nosebleedsarerarelyacauseforalarm.Theyarecommoninchildrenages3-10years.Sincemostnosebleedsinchildrenarecausedbynosepickingorirritationduetohotdryair,usingafewsimpletipsmayhelpchildrenavoidtheminthefuture.

CareAdvice:

Howtostopthebleeding• Staycalmandreassurechild.• Withchilduprightinachairorincaregiver’slap,tiltchild’sheadslightlyforward.DONOThave

yourchildleanback.Thismaycausebloodtoflowdownthebackofthethroat,whichtastesbadandmaycausegagging,coughing,and/orvomiting.

• Gentlypinchthesoftpartofthenosewithyourthumbandforefinger(justbelowthebonyridge)withatissueorcleanwashcloth.

• Keeppressureonthenoseforabout10-15minutes.Ifyoustoptoosoonthebleedingmaystartagain.Ifthebleedingdoesnotstop,makesureyouareputtingpressureontherightspot.

• Ifthebleedingdoesnotstop,parentsmayuseAfrinnosesprayforchildrengreaterthan6yearsofage.TheAfrincanbeusedtwiceadayfornomorethan3daysinarow.

• YoumayuseprescriptionmedicationsuchasAmicarortranexamicacidifithasbeenprescribedbythehematologistorHemophiliaTreatmentCenter.

• Haveyourchildrelaxforawhileafterthenosebleed.Discouragenoseblowing,picking,rubbing,oranyroughplay.

• Ifbleedingcontinuesforgreaterthan30minutes,yourchildneedstobeseenintheEDforfurtherevaluation.

Prevention• Keeptheinsideofyourchild’snosemoistwithSalineNasalGelwhichcanbeboughtoverthe

counter,e.g.AYRgelorwithVaseline,coconutoroliveoil.Dabgentlyaroundthebaseoftheopeningofthenostrils.

• Encouragefluidssoyourchildcanstaywellhydrated.• Humidifybedroomsiftheairinthehomeisdry.Thisisespeciallyimportantwhentheoutsideair

isdryorduringwintermonthswhenheatersareon.Eitherwarmorcoolmisthumidifiersarefine.

• Makesurethechildwearsprotectiveathleticequipmentwhenparticipatinginsportsthatcouldcauseanoseinjury.

• Avoidaspirin,ibuprofenandotherNSAIDsasthesemedicinescanmakebleedingworse.• Takeprecautionssuchaskeepingthenailsshortandfiled

02/2021 Epistaxis (Nosebleeds) Page 2 of 2

Epistaxis (Nosebleeds)

PATIENT EDUCATION

Forchildrenwithrecurrentnosebleedsdespiteusingthemoisturepreventions,sometimestheymayneedtoseeanEar,NoseandThroatspecialist.Sometimes,thechildmayneedanasalcauteryprocedurewhichcanbedoneintheofficeorintheoperatingroomdependingontheirage.Theproceduremayhelpdecreasethefrequencyofthenosebleed,butitisrarelyaCURE.SoitisimportanttocontinuedoingthethingswementionedinthePreventionsection.NasalCautery-PostProcedureSometimesthenosewillcontinuetohavesomebleedingaftertheprocedurewhichisnormal.Itshoulddecreasewithtime.Followthesameprecautionsaslistedabovetohelpthenosestaymoistandclotproperlyifthereisableed.FollowupwithENT(nextavailableappointment)forrecurrentnosebleeds.Call858-309-7701tomakeanappointment.Ifyourchildhasaknownbleedingdisorder,talktoyourhematologist/oncologistabouthowtooptimizeyourbloodcountorothermedicationsyoumayneedtopreventrecurrentbleeding.PleasetakeyourchildtotheEmergencyDepartmentifyouareunabletostopnosebleedforgreaterthan30minutes.

WhentocallourofficeIfyouareanestablishedpatient,callourofficeoron-callemergencynumberbelowwhenanosebleedhaslastedformorethan30minutes.Callifchildisweak,dizzy,pale,orextremelytiredafteranosebleed.Callourofficeduringthedayifnosebleedsareafrequentproblemevenaftersalinegels,salinesprayandhumidificationareusedoryouhaveotherconcernsorquestions.Ifyouareanestablishedhematologypatient,forquestionsduringthedaypleasecontacttheappropriatecasemanager:

KappiFarrow,BSN,RN,CPNHemophilia/BleedingDisorderCaseManager858-966-7918RosalieBrooks,RNThrombosis/ClottingDisorderCaseManager858-966-8647BethShehee,BSN,RNSickleCell/HematologyDisorderCaseManager858-966-6709

Forafter-hoursemergencyoronweekends,callthehospitaloperatorat858-576-1700andasktospeakwiththehematologiston-call.