Epistaxis (Nose Bleed)

Jul 16, 2023
3 min read

Introduction

Epistaxis is bleeding from the nose – a common presentation in children. Epistaxis is usually manageable with simple first aid measures and advice on behavioural triggers (nose-picking). Epistaxis can be acute or recurrent. Recurrent epistaxis can sometimes indicate an underlying pathology e.g. angiofibroma or coagulation disorder.

Epidemiology

Although epistaxis is fairly common amongst the entire population, epistaxis has a bimodal distribution due to different causative factors. In children the most common causative factor is nose-picking. Narrower nasal airways seen in children are also more prone to bleeding and inflammation in general. In the elderly population the trigger is often an anti-coagulant medication to treat or prevent other medical conditions. Epistaxis in children under the age of 2 is relatively rare and should be referred to ENT for investigation.

Definition

Epistaxis, also known as a nosebleed, is a common occurrence in children. It is the bleeding of the nose that can be caused by a variety of factors.

Causes

The most common cause of epistaxis in children is picking the nose. Other causes include:

Dry air
Infections, such as a sinus infection or the common cold
Allergies
Medications, such as aspirin or blood thinners
Trauma, such as a blow to the nose
Certain medical conditions, such as high blood pressure or blood clotting disorders

Signs and Symptoms

The signs and symptoms of epistaxis vary depending on the severity of the bleed. They may include:

Blood coming from one or both nostrils
Blood dripping down the back of the throat
A headache
Nasal congestion
Fatigue
Dizziness
Lightheadedness
Confusion
Syncope (fainting)
Pain in the nose
Sneezing
Coughing
Difficulty breathing

Diagnostic Evaluation

In most cases, a doctor will be able to diagnose epistaxis based on the child's medical history and a physical exam.

Here are some of the specific diagnostic tests that may be ordered:

Complete blood count (CBC): This test measures the number of red blood cells, white blood cells, and platelets in the blood. A low platelet count or abnormal white blood cell count can indicate a bleeding disorder.
Coagulation profile: This test measures the ability of the blood to clot. A prolonged bleeding time or abnormal coagulation factors can indicate a bleeding disorder.
Nasal endoscopy: This test allows the doctor to visualize the inside of the nose and identify the source of the bleeding. The doctor will use a small, flexible tube with a camera attached to the end to view the inside of the nose.
CT scan of the nose and sinuses:This test provides a detailed image of the nose and sinuses. This can be helpful in identifying any underlying structural abnormalities, such as a deviated septum or a tumor.

Treatment

In most cases, epistaxis can be stopped at home by applying pressure to the nose for 5 to 10 minutes. You can also use a cold compress or a saline nasal spray. If the bleeding is severe, you may need to see a doctor.

Here are some of the treatment options for epistaxis:

Medical treatments for epistaxis include:

Topical vasoconstrictors: These medications can help to shrink the blood vessels in the nose and stop the bleeding. They are usually applied as a nasal spray or drops.
Cauterization: This procedure involves using heat or chemicals to seal the bleeding blood vessels.
Nasal packing: This procedure involves inserting a gauze or foam pad into the nose to apply pressure to the bleeding blood vessels.
Arterial ligation: This procedure involves tying off the blood vessels that are bleeding.

Other treatments for epistaxis may include:

Blood transfusions: If the bleeding is severe, the patient may need a blood transfusion.
Antibiotics: If the bleeding is caused by an infection, antibiotics may be prescribed.
Medications to control blood clotting: If the patient has a blood clotting disorder, medications may be prescribed to help control the bleeding.

The best treatment for epistaxis will depend on the individual patient's circumstances. The doctor will discuss the options with the patient and recommend the best course of treatment.

Prevention of epistaxis:

There are a few things you can do to help prevent epistaxis, including:

Avoid picking your nose.
Use a humidifier to add moisture to the air.
Take over-the-counter decongestants.
Avoid taking medications that can increase the risk of bleeding.

If you have a history of epistaxis, you should talk to your doctor about ways to prevent future episodes.

Conclusion

Epistaxis is a common occurrence in children. It is usually not serious and can be stopped at home. However, if the bleeding is severe or does not stop after a few minutes, you should see a doctor.

I hope this helps!