My 10-year-old daughter often has nosebleeds. We were recently in dry weather and she had a nosebleed that lasted for two hours. Yesterday, approximately seven days after the nosebleed, she tells me that she is swallowing blood. I called her physician, who said that the nosebleed is anterior, and that she does not have to come in to see a doctor. Do you agree?
Nosebleeds are a fairly common problem for children. Your doctor’s suggestion that it is probably coming from the front of the nose is based on the odds. Most nosebleeds come from the septum, or middle of the nose, down near the opening. Frequently there are blood vessels very close to the surface that get irritated and dry out easily, causing a nosebleed. Dry air, especially wintertime air, and dry heat are usually what make the nosebleeds worse. Younger children who tend to pick at their nose will often cause an irritated nose to bleed. Taking cold medicines with antihistamines will also dry out the nose, making it bleed more easily.
Occasionally, children may have a medical problem that makes the nose bleed more easily. High blood pressure increases nosebleeds. Some children may have a problem that prevents their blood from clotting. Usually, if a child has this sort of a problem you will know other people in your family who also have trouble clotting. You may also notice that your daughter tends to heal more slowly when she gets a cut or that she bruises more easily that other children.
When your daughter gets a nosebleed, you should have her pinch the bottom of her nose, just as you would hold pressure on a cut. Don’t release the pressure for at least ten minutes, even to peek and see if the bleeding stops. Every time you release the pressure you slow down the process that forms a clot or scab that is necessary to stop the bleeding. The blood she swallows is not harmful, but may give her an upset stomach. Often when children’s nosebleeds stop, they have to sneeze. A big clot of blood may come out. Again, don’t be worried about that.
Children who have frequent nosebleeds, especially if they don’t stop after holding constant pressure for ten minutes, should see the doctor within a day or two. The doctor can look in the nose to see if the bleeding comes from the front of the nose, and check the blood pressure. The doctor will also decide if there is a need for tests that check your daughter’s ability to form a clot. Usually the doctor will recommend putting petroleum jelly under the nose and running a humidifier to keep the air moist. The doctor may decide to put a medication called silver nitrate on the blood vessels so they don’t bleed so easily, but this may sting a little bit.
As always, if you are concerned, call your doctor again.