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Recurrent Nosebleeds: When to Worry

It is not unusual for children to experience nose bleed. Nose bleed also known as epistaxis is a hemorrhage in the nose characterized by blood passing through the nose. Nosebleeds are classified into 2 types, the anterior epistaxis and posterior epistaxis. Anterior nosebleeds occur in the outer portion of the nose or nares, while posterior nosebleeds involve the inner portion. Between the 2 types, posterior nosebleed is more serious since it is potentially caused by an underlying medical condition. The causes of epistaxis are also classified into 2 types, local and systemic. Some nosebleeds are not caused by anything, which means they cannot be classified to either local or systemic.

Local factors that cause nosebleeds include blunt trauma brought about by blows in the face and areas near the nose, foreign bodies such as the fingers, swabs and insects that enter the nasal cavity and inflammatory reactions due to environmental irritants, allergic rhinits and respiratory tract infections. Other local factors that contribute to nosebleeds are narcotics like cocaine, anatomical deformities, nasal tumors and nasal surgery. The most common systemic factors that cause epistaxis are hypertension, allergies and infectious diseases. Colds and flu also causes epistaxis. Various factors like alcohol, vasodilators, anemia, hematologic and blood disorders, vitamin C and K deficiency as well as connective tissue disease can potentially lead to nosebleeds.

Treatment for nosebleeds is focused in stopping the bleeding and preventing recurrence. For children with nosebleeds, the first thing parents and caretakers can do is slow the bleeding down by means of direct pressure. This can be done by gently squeezing the nose shut using a soft absorbent cloth or warm moist cotton on the side of the bleeding nose. The nose is carefully squeezed until bleeding stops. Applying a small ice pack over the nose for 10 minutes can also help stop bleeding. While the nose is closed, the child must be taught to breathe through his mouth. Direct pressure can also be applied over the bridge of the nose. This mechanism can help minimize the blood vessels in the nose preventing nosebleeds. The best position the child can assume when having epistaxis is lying down with head tilted forward. The pressure should be applied until bleeding has subsided. There is an available over the counter medication called neo-synephrine or Afrin nasal spray that can shrink the blood vessels and slow down stubborn bleeding. This spray is applied directly into the nose, relief will happen within 10 minutes. Aside from these measures, there are other means of preventing nosebleeds. Keeping the nose moisturized will maintain the nasal lining. Effective moisturizers include Vaseline, lanolin ointment and nasal saline mist which can be used 2 to 3 times per day.

Recurrent nosebleeds should cause an alarm to parents and caretakers when it is accompanied by severe headaches. Nosebleeds with headaches may indicate hypertension or high blood pressure, managing the underlying condition can stop bleeding. Nosebleeds with bleeding on unusual areas like the gums, urine and stool needs to be thoroughly examined. This form of nosebleed is occasionally accompanied by bruising. Conditions like this could indicate bleeding disorders or leukemia.

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