Nosebleeds: first aid, causes and when to seek help, a review

A nosebleed can look alarming, but most are harmless and stop with simple first aid. Knowing what to do, and which signs need medical attention, helps people stay calm and safe. This review uses information from the NHS and from HealthyChildren.org, the website of the American Academy of Pediatrics.

1. Introduction

The NHS says nosebleeds are not usually a sign of anything serious. They are common, especially in children, and most can be treated at home ^[1]. HealthyChildren.org says most causes of nosebleeds in children are not serious ^[3]. Sometimes no cause is found ^[1].

2. Causes and risk factors

The NHS says the most common causes are picking the nose, blowing it too hard, and dryness inside the nose, for example after a change in air temperature. Deeper bleeds, more often seen in adults, can follow an injury or broken nose, conditions that affect blood vessels or clotting, or medicines that thin the blood. Higher risk groups include children, adults over 45, pregnant women and people with high blood pressure ^[1].

HealthyChildren.org adds colds and allergies that irritate the nose, dry or irritating air such as cigarette smoke, non-cancerous growths called polyps, and medicines such as ibuprofen. It also names bleeding disorders such as haemophilia (hemophilia) and von Willebrand disease, which affect how blood clots ^{[2, 3]}. Children may push small objects into the nose ^[2].

3. Signs and symptoms

A nosebleed is bleeding from one or both nostrils. Blood may also run down the back of the throat, and swallowing a lot of blood can cause vomiting ^{[1, 2]}. Bleeding that comes with feeling weak, dizzy, pale, sweaty or short of breath is more worrying ^{[1, 2]}.

4. First aid: how to stop a nosebleed

The NHS and HealthyChildren.org give very similar steps ^{[1, 2, 3]}:

1. Stay calm. The bleeding is usually not serious, and a child picks up on a parent's mood.
2. Sit or stand and lean slightly forward, with the mouth open, so blood does not run down the throat. Do not lie down or tilt the head back.
3. Pinch the soft part of the nose firmly.
4. Keep pinching for 10 to 15 minutes without letting go to check. Checking early can restart the bleeding.
5. Breathe through the mouth. A cold compress or cold pack on the nose may help, although the NHS says evidence is weak.
6. If bleeding continues, repeat the pressure for another 10 minutes. If it still has not stopped, call a doctor or go to the nearest emergency department.

Do not stuff tissue or gauze into the nose ^{[2, 3]}.

5. Diagnosis and treatment

If a nosebleed is heavy or keeps coming back, a doctor may treat it. The NHS says that if the doctor can see the bleeding point, it may be sealed with a chemical-tipped stick. If not, the nose may be packed with gauze or sponge, which can mean staying in hospital for a day or two. An antiseptic cream may be given afterwards to prevent crusting ^[1]. HealthyChildren.org says a child with more than 5 nosebleeds a year or bleeding lasting over 10 minutes may be tested for a bleeding disorder and may be referred to an ear, nose and throat (ENT) specialist ^[3].

6. Prevention and self-care

For 24 hours after a nosebleed, the NHS advises not blowing or picking the nose and not picking scabs, avoiding hot drinks and alcohol, avoiding heavy lifting and strenuous exercise, and avoiding lying flat ^[1].

To lower the chance of future nosebleeds, HealthyChildren.org suggests ^{[2, 3]}:

• Discourage nose picking and keep objects out of children's noses.
• Use a humidifier to keep indoor air moist.
• Ask a paediatrician about saline (salt water) nose drops or a small amount of petroleum jelly inside the nostrils at night, particularly in dry climates.
• Check with a doctor before using medicated nose drops or sprays, because some can make congestion worse after a few days of use.

7. Special groups

The NHS advises that a child under 2 who has a nosebleed should see a doctor. Anyone taking a clot-preventing medicine, or who has a clotting disorder, should also seek medical advice if they bleed ^[1]. Frequent nosebleeds with signs of anaemia, such as palpitations, breathlessness or unusually pale skin, need a doctor's review ^[1].

8. When to see a doctor

See a doctor if nosebleeds are regular, or in the special groups above ^[1]. Go to hospital urgently if bleeding lasts longer than 10 to 15 minutes, seems excessive, started after a blow to the head, makes you swallow a lot of blood and vomit, or comes with weakness, dizziness or trouble breathing ^[1]. For a child, HealthyChildren.org advises calling the doctor right away if the child is pale, sweaty or not responding, or is vomiting blood or brown material that looks like coffee grounds ^[2]. The NHS says not to drive yourself and to take your medicines with you ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

9. Conclusion

Most nosebleeds settle with sitting forward and firm, steady pressure on the soft part of the nose. Keeping the nose moist and avoiding picking can lower the chance of another one. Heavy, long-lasting or repeated bleeding should be checked, and your doctor decides what tests or treatment are needed.