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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Crime Scene? or Nose Bleed?

I have a few friends whose kids have regular nosebleeds, and I’m telling you, when it happens it looks like a crime scene. It’s hard to believe that so much blood can come gushing out of a little tiny space and make it appear like that child is bleeding to death, but I think I can get a few witnesses here on this to back me up. It’s incredible.

The nosebleeders I know have had to:

1. pull over on the side of the Capitol Beltway to manage the bloodbath in the backseat of their car
2. cut an entire kid birthday party short after blunt force trauma intended for a piñata went awry
3. go to the hospital after TWO HOURS of nonstop bleeding, because it just wouldn’t stop

So what’s the over/under on this, anyway? Some people appear to have ZERO issues with this, and other people have had to purchase entire wardrobes over and over because all of their clothes are blood stained.

The answer is typically pretty simple

for those who don’t have an underlying bleeding problem, and it’s all in the anatomy. We all have a vascular plexus (I’m wild about that 25 cent word which just means “nest of blood vessels”) that lives in our noses called Kiesselbach’s plexus, named after a guy who apparently was super interested in the inside of noses (!!). In some people, this plexus lives near the surface of the lining of the nose, and in some people it’s located deeper. Those whose plexus lives near the surface are our friendly neighborhood regular nosebleeders because if anything disrupts that plexus: nose picking, dry air, trauma, inflammation, or whatever, the blood letting begins. And continues. And goes on.

Regardless, the treatment is the same for anyone with a nosebleed. Let’s do the mythbusting first:

1. Don’t tilt the head back– it doesn’t help and makes the blood just drain in the throat, which is irritating in the stomach and could make someone choke.
2. Ice on the nose or forehead doesn’t work. It just doesn’t. Too far away from the active bleeding site.

So, here’s what to do:

1. Like with any bleeding situation, APPLY PRESSURE. That means squeeze the nostrils together, tightly. I tell people to do it for 10-15 minutes, solid. No peeking. And that isn’t easy.
2. If that doesn’t work I try a nasal decongestant such as Afrin- the decongestant also constricts blood vessels and that helps to stop the bleeding.
3. If you’re working on about an hour or so of oozing and bleeding, time to seek medical care. There are some other tricks that we have, like inserting some clotting “plugs” up the nose (I know I made that sound appealing…), but that needs to be done in a medical environment.

For truly recurrent nosebleeders…

there may be some medical investigation that needs to occur to make sure there’s not a bleeding/clotting disorder, but for the overwhelming majority of them it really comes down to the simple variations in body plumbing. At the end of the day, after an entire bottle of stain remover has been used, all these guys do just fine. Especially when they line the inside of their nostrils with petroleum jelly and do not blow or pick their nose for a good 24 hours after the bleeding stops.

Yours in the spirit of nosebleed drama,
Dr. C

Go to previous article: Eye of the Newt, Wart of the Toad (not quite Shakespeare)

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