Everyone would have experienced at least one episode of nose bleeding in their lives. The manner in which bleeding occurs usually determines whether a person with nosebleeds seek medical help or not. Most people tend to dismiss an occasional slight blood staining of nose discharge when blowing or digging the nose. Severe bleeding from the nose, especially when the problem is recurrent can however be frightening and socially embarrassing. People with troublesome bleeds tend to seek help earlier.

Nose bleeding in children, especially if recurrent, can be an extremely distressing problem to cope with. Parents are often called by teachers in school when a child’s nosebleed frequently disrupts class activities. Waking up in the morning with blood-stained pillow cases caused by nosebleeds during sleep can also be a traumatic experience for children.

Fortunately, nosebleeds from life-threatening causes are very rare in children.

The Little’s area can cause a big problem

The Little’s Area

Most of the nosebleeds in children occur in an area located on the nasal septum (the midline wall that divides the right nostril from the left) near the entrance of the nose. This is called the Little’s area, a patch of mucosa rich in tiny blood vessels. This area is frequently subjected to surface tears when we dig our nose with our fingers, rub our nose too hard or insert tissue paper to clean the inner part of our nostrils. Blowing the nose too aggressively can also result in bleeding from Little’s area.

First aid measures to stop nosebleeds in children
Nothing is more important than to stay calm when we help a child with nosebleed. Sit the child down and press the sides of his nostrils together. Ask the child to lean forward and make him breathe through his mouth. Bleeding usually stops in a few minutes. Whenever possible, place an ice pack over the forehead, face or neck to quicken the cessation of bleeding.

Causes of nosebleeds in children
Nose allergy remains the commonest cause of nose bleeding in children. Nose blockage, nose discharge and nose crusting that result from allergic rhinitis are the usual precursors of nosebleeds. Malignancy of the nose and sinuses are extremely rare in children.

Definitive treatment
Treatment of allergic rhinitis with nasal steroids, antihistamines and environment control measures is the key to treating children with frequent nosebleeds. In children who have prominent blood vessels in the Little’s area, treatment with a chemical called silver nitrate is an effective treatment option. Silver nitrate is applied onto the Little’s area under topical anesthesia. The chemical reaction that results causes scarring of the blood vessels. Larger vessels can be treated with electro-cautery, a simple procedure that requires application of a special electrical applicator to ablate blood vessels. In adults, this form of treatment can be undertaken in the clinic under local anesthesia. For children, electro-cautery is usually carried our under sedation or general anesthesia.