Selected Podcast
What to Do When Your Kid Gets a Nosebleed
Amina Ahmed, MD discusses what you need to know about nosebleeds in kids and what to do.
Featured Speaker:
Learn more about Amina Ahmed, MD
Amina Ahmed, MD
Amina Ahmed, MD is Stanford Children's Health Pediatrician at South Bascom Pediatrics in Los Gatos.Learn more about Amina Ahmed, MD
Transcription:
What to Do When Your Kid Gets a Nosebleed
Scott Webb: Nosebleeds in our kids are common, from trauma, dry air, allergies and many other reasons. And I'm joined today by Dr. Amina Ahmed. She's a Stanford Children's health Pediatrician, and she's going to share best practices for stopping nosebleeds and how to keep our kids calm when they happen.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. So doctor, thanks so much for your time today. I was mentioning that I have a couple of kids and certainly nosebleeds were common when they were younger and as I'm sure they are for other parents and their children. And you and I were just sort of mentioning that it's such a common thing, but people don't talk about it much. So I'm so glad that we're doing that today. And we have your expertise, because we may all be doing it wrong. Maybe that's why the nosebleeds, you know, last longer than they should. So as we get rolling here, how common are nosebleeds in our children?
Dr. Amina Ahmed: Nosebleeds are pretty common in kids. If we just look at the whole population, like the US population, almost 60% of people will get a nosebleed at some point in their life. Kids, you know, younger than five, they're pretty common, like one-third of them will get it. And between six and 10-year-old kids, almost half of them will get a nosebleed at some point.
Scott Webb: Yeah. And it seems to me that sometimes nosebleeds, it's obvious what the cause is, right? Somebody runs into somebody, somebody punches somebody. However it happens, some nosebleeds are the result of some sort of trauma or incident or accident, whatever it is. And then other times you just sort of look over in the dugout and some kid's nose just starts bleeding. So wondering if you could go through the really obvious causes of nosebleeds and maybe some of the less obvious reasons why a child's nose might start to bleed unexpectedly, so maybe you can help us understand why.
Dr. Amina Ahmed: You're so right. Sometimes you could see why a nose bled. So, you know, a kid bumps into another kid and they hurt their nose and you can see why it's bleeding. But there are other times, your kid might just wake up in the morning and they've had a nosebleed or just during the day, they just come running to you after playing and that their nose is bleeding. So that's pretty common.
Typically, like you alluded to, trauma is one of the more common causes and sometimes you'll see the trauma. The other times, very common way the kids kind of traumatize their nose is by picking at it. And young kids especially, they will dig into their noses and, you know, obviously if they scratch anything on the inside, that can bleed. And also, then the other is, kids younger than three years old, they will sometimes even put something, a bead up their nose or anything else, that can also scratch on the inside and cause a bleeding, et cetera.
But the other most common reasons that can happen is dryness in the air, right? So winters especially, and you've got to your heating wing on high in the house, then because of all that dry air, it can cause irritation in the mucosa or the inner lining of the nose, and that can cause a cracking up of the inner lining, irritation and bleeding from there.
So just to kind of give you a little backdrop, the inner lining of the nose is very sensitive. You can think of it like how your lips are very moist, thin, friable. And just like in dryness, your lips can chap. And when they chap and crack, they can tend to bleed a lot. It's pretty much similar like that. So if on the inside of your nose, if you're constantly just breathing dry air and, you know, there's not a lot of humidity in the air, then the inner lining can get dry, can get cracked and there can be bleeding from there too. Those are the most common reasons why.
Scott Webb: You know, so doctor, as you mentioned, there's a variety of reasons, right? Dry air, trauma. Children obviously, especially when they're younger, they stick their fingers in their noses, they stick toys up their noses and so on. So I think the million dollar question is here, for whatever the reasons, whatever may have caused the nosebleed, and I mentioned before we got rolling that maybe grandma's way of stopping a nosebleed isn't the most current medical standards. So, share with me and those listening, what's the best way to stop one of these nosebleeds?
Dr. Amina Ahmed: You know, I want to acknowledge first like it is pretty scary to see a kid with a bloody nose and blood coming down their face and it's pretty scary for the kid too. So a lot of times they'll be scared themselves. First thing is to stay calm, because just to know that it is pretty common, only maybe less than 1% of nosebleeds end up in the ER. So most of the time, it's the common things that we've talked about. So the kid is going to feed off your anxiety. If you're anxious, they're going to get anxious. So first thing is to just stay calm. Then, you know, a lot of times people used to have the kids lie down, but we don't recommend that, because that could just cause swallowing up the blood and choking on it. So have the kids sit up or stand. Tilt their head forward a little bit. And the next is to kind of pinch the nose. What that does is it just provides a lot of compression on where the bleeding is and helps it stop. So the spongy part of the nose, the really front part of it, just pinch it hard and then just hold it there for at least five or ten minutes. Now that can seem like eternity, five or ten minutes at that time. I'm a mom myself, so I know. You know, it's like, "Oh, should peek in? Can we see if it's stopped?" But for this whole clotting to happen and the bleeding to stop, we do need to give it time. So if you keep on peaking, like, you know, after 10 seconds, release the pressure and try to see if the bleeding has stopped, it'll just start all over again. Sometimes I'd even tell my patients, you know, keep a timer or sing the song and sing the whole song through our line through, and then kind of let go. So, you know, that five minutes have gone by. At least five or 10 minutes of that pressure on the nose, that will help stop the bleeding.
Scott Webb: Yeah, that's such great advice. And I was just thinking, you mentioned about staying calm and that's so necessary in these situations, but it's hard, you know, especially if it was a result of some traumatic thing. And as we talked about earlier, sometimes we know the causes, trauma, whatever it might be, whether we know the causes or not, if our child is having chronic nosebleeds, often enough that we notice that they're happening so often, what should we do about that? Should we speak to the pediatrician? I'm assuming you don't recommend just running to the ER, let's not be that dramatic, of course, because you mentioned being calm. But, you know, when are chronic nosebleeds something that we should be concerned about?
Dr. Amina Ahmed: That's a great question, Scott. So when do you worry about it? And I'll kind of like answer this question two parts, right? So when do you worry about it? Let's say in the acute moment when it's happening, because there can be sometimes reasons why you would need to go to the ER or the bleeding could be a lot. So let's say if you tried pinching the nose for five minutes and, you know, the bleeding has not stopped and the child is profusely bleeding from the nose or even choking on the blood, you know, or gasping for air, those are not good signs. Definitely, we need to take a look a little deeper and figure out what's going on or where the bleeding is coming from. So those are situations where you would take the child to the ER, if there is choking, there's more serious bleeding,
And the other situation is when they're chronically bleeding, right? So they bleed once, but they constantly, let's say two or three times in the week, and for two to three weeks, they are constantly having these nosebleeds or recurrent nosebleeds, then you do want to go to the pediatrician or talk to them about it, because there could be other reasons why bleeding can happen and that's what your pediatrician would make sure that there's no underlying illness or any growth in the nose or anything which is causing all this bleeding.
One other common reason that we didn't cover is allergies. So if there are allergies and they're using some nasal medications, you know, sometimes if they're squirting medication inside the nose itself and causing some of those bleedings, that can also happen. But nonetheless, they should talk to their pediatrician about it if they're recurrent nosebleeds.
Scott Webb: Yeah. So you mentioned there, doctor, like there may be times when a nosebleed is bad enough to go to the ED or, if it's chronic, we should at least reach out to the pediatrician. But, you know, knowing children and you have children, I have children, kids don't always cooperate. Like sometimes they have issues like a nosebleed after hours and maybe it doesn't quite rise to the level to go to the emergency department and we're sort of caught in between, there is some after-hours care available, right?
Dr. Amina Ahmed: Yes. Yes. And, you're right, Scott. We do have an after-hours program, a virtual clinic that runs from 6:00 PM until 9:30 PM. And this is exactly why we are there to help you out. So in those situations where you're not sure what to do, you know, should you be rushing to the ER? Is it bad enough or not? So we do have the virtual clinic. It's like a telehealth. And so you can go to the website, like, after hours, stanfordchildrens.org and schedule the child in. And one of us, one of the Stanford pediatricians, we staff those clinics. So we will be there and we're more than happy to talk to you and go over questions if the nosebleed is severe enough, if it can be managed at home, can it wait until the morning or do you need to go to the ER? So yeah, we'll go over all those questions with you.
Scott Webb: Yeah. You know, we've talked about remaining calm and sort of not wanting to freak our kids out. How can we sort of address things with them? How do we explain nosebleeds? How can we prevent them? And mainly, how can we, you know, prepare them so that they don't freak out?
Dr. Amina Ahmed: Kids learn from us, you know, and there are great opportunities to talk about it. You know, it's a common thing and we do a little treatment like you pinch the nose and kind of prepare them for it. So those little kind of incidental events that happen in life, they are good teaching opportunities that kids can learn from. There's nothing scary. If it does happen, what to do next, to pinch their nose if a friend has it or they have it, and then seek help from an adult. And it could happen because of just a little bit of dryness in the nose, et cetera. So the kids can stay calm about it and they don't worry that something major is happening.
The other thing is how to prevent it. If this is happening because of dryness, then you could always use some over-the-counter nasal saline drops in the nose. They use them daily. Put one or two drops on each side to help moisten the mucosa and prevent any dryness and bleeding from the dryness in the nose.
Another thing is to use a humidifier, you know, in the house. If you have had the heating on or you know that the air is very dry. In California, deceptively dry. So it's good to kind of keep that humidifier next to their bed and it'll help kind of moisten the air and the nasal mucosa.
Scott Webb: Yeah, good stuff today. A lot of fun, a lot of education here. And doctor, as we wrap up, you know, we prefaced by saying nosebleeds are common and we have a pretty good sense of why our children get them and how we can stop them. But what would be your takeaways for parents, whether it's about remaining calm or anything else?
Dr. Amina Ahmed: First and foremost, like you mentioned, I would emphasize staying calm. And even I'm a parent and a pediatrician myself, I have to remind myself of that too, you know? Because when it comes to your child, you know, it's natural to feel anxious. So, one is to stay calm. Remind yourself, I'm going to go step by step through this and we'll figure out what's going on.
The other is kind of look out for worrisome signs, the things that we've talked about. You know, if your child doesn't look good, if they're choking on the blood, if there's a lot of bleeding or bleeding from other areas in the body, the bleeding in their gums as well, or they have rashes on their body or bruises on their body, those are all worrisome signs, so do talk to your pediatrician about it. And we're here to help. And if you're anxious about it at all, like you mentioned, have a telehealth, you know, if you don't want to come in. But at least get information from us, get the right information. And we're more than happy to tell you what to do, go over history and talk about if there are any worrisome signs that need further workup.
Scott Webb: Yeah. Well, that's perfect. And I've said it before, and I'll say it again on these podcasts, you know, pediatricians are just the best. Just knowing what the latest options are, the latest treatment and all of that is so good to hear from you. So thanks so much and you stay well.
Dr. Amina Ahmed: Thank you so much. It was a pleasure talking to you.
Scott Webb: And for more information, visit stanfordchildrens.org.
And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.
What to Do When Your Kid Gets a Nosebleed
Scott Webb: Nosebleeds in our kids are common, from trauma, dry air, allergies and many other reasons. And I'm joined today by Dr. Amina Ahmed. She's a Stanford Children's health Pediatrician, and she's going to share best practices for stopping nosebleeds and how to keep our kids calm when they happen.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. So doctor, thanks so much for your time today. I was mentioning that I have a couple of kids and certainly nosebleeds were common when they were younger and as I'm sure they are for other parents and their children. And you and I were just sort of mentioning that it's such a common thing, but people don't talk about it much. So I'm so glad that we're doing that today. And we have your expertise, because we may all be doing it wrong. Maybe that's why the nosebleeds, you know, last longer than they should. So as we get rolling here, how common are nosebleeds in our children?
Dr. Amina Ahmed: Nosebleeds are pretty common in kids. If we just look at the whole population, like the US population, almost 60% of people will get a nosebleed at some point in their life. Kids, you know, younger than five, they're pretty common, like one-third of them will get it. And between six and 10-year-old kids, almost half of them will get a nosebleed at some point.
Scott Webb: Yeah. And it seems to me that sometimes nosebleeds, it's obvious what the cause is, right? Somebody runs into somebody, somebody punches somebody. However it happens, some nosebleeds are the result of some sort of trauma or incident or accident, whatever it is. And then other times you just sort of look over in the dugout and some kid's nose just starts bleeding. So wondering if you could go through the really obvious causes of nosebleeds and maybe some of the less obvious reasons why a child's nose might start to bleed unexpectedly, so maybe you can help us understand why.
Dr. Amina Ahmed: You're so right. Sometimes you could see why a nose bled. So, you know, a kid bumps into another kid and they hurt their nose and you can see why it's bleeding. But there are other times, your kid might just wake up in the morning and they've had a nosebleed or just during the day, they just come running to you after playing and that their nose is bleeding. So that's pretty common.
Typically, like you alluded to, trauma is one of the more common causes and sometimes you'll see the trauma. The other times, very common way the kids kind of traumatize their nose is by picking at it. And young kids especially, they will dig into their noses and, you know, obviously if they scratch anything on the inside, that can bleed. And also, then the other is, kids younger than three years old, they will sometimes even put something, a bead up their nose or anything else, that can also scratch on the inside and cause a bleeding, et cetera.
But the other most common reasons that can happen is dryness in the air, right? So winters especially, and you've got to your heating wing on high in the house, then because of all that dry air, it can cause irritation in the mucosa or the inner lining of the nose, and that can cause a cracking up of the inner lining, irritation and bleeding from there.
So just to kind of give you a little backdrop, the inner lining of the nose is very sensitive. You can think of it like how your lips are very moist, thin, friable. And just like in dryness, your lips can chap. And when they chap and crack, they can tend to bleed a lot. It's pretty much similar like that. So if on the inside of your nose, if you're constantly just breathing dry air and, you know, there's not a lot of humidity in the air, then the inner lining can get dry, can get cracked and there can be bleeding from there too. Those are the most common reasons why.
Scott Webb: You know, so doctor, as you mentioned, there's a variety of reasons, right? Dry air, trauma. Children obviously, especially when they're younger, they stick their fingers in their noses, they stick toys up their noses and so on. So I think the million dollar question is here, for whatever the reasons, whatever may have caused the nosebleed, and I mentioned before we got rolling that maybe grandma's way of stopping a nosebleed isn't the most current medical standards. So, share with me and those listening, what's the best way to stop one of these nosebleeds?
Dr. Amina Ahmed: You know, I want to acknowledge first like it is pretty scary to see a kid with a bloody nose and blood coming down their face and it's pretty scary for the kid too. So a lot of times they'll be scared themselves. First thing is to stay calm, because just to know that it is pretty common, only maybe less than 1% of nosebleeds end up in the ER. So most of the time, it's the common things that we've talked about. So the kid is going to feed off your anxiety. If you're anxious, they're going to get anxious. So first thing is to just stay calm. Then, you know, a lot of times people used to have the kids lie down, but we don't recommend that, because that could just cause swallowing up the blood and choking on it. So have the kids sit up or stand. Tilt their head forward a little bit. And the next is to kind of pinch the nose. What that does is it just provides a lot of compression on where the bleeding is and helps it stop. So the spongy part of the nose, the really front part of it, just pinch it hard and then just hold it there for at least five or ten minutes. Now that can seem like eternity, five or ten minutes at that time. I'm a mom myself, so I know. You know, it's like, "Oh, should peek in? Can we see if it's stopped?" But for this whole clotting to happen and the bleeding to stop, we do need to give it time. So if you keep on peaking, like, you know, after 10 seconds, release the pressure and try to see if the bleeding has stopped, it'll just start all over again. Sometimes I'd even tell my patients, you know, keep a timer or sing the song and sing the whole song through our line through, and then kind of let go. So, you know, that five minutes have gone by. At least five or 10 minutes of that pressure on the nose, that will help stop the bleeding.
Scott Webb: Yeah, that's such great advice. And I was just thinking, you mentioned about staying calm and that's so necessary in these situations, but it's hard, you know, especially if it was a result of some traumatic thing. And as we talked about earlier, sometimes we know the causes, trauma, whatever it might be, whether we know the causes or not, if our child is having chronic nosebleeds, often enough that we notice that they're happening so often, what should we do about that? Should we speak to the pediatrician? I'm assuming you don't recommend just running to the ER, let's not be that dramatic, of course, because you mentioned being calm. But, you know, when are chronic nosebleeds something that we should be concerned about?
Dr. Amina Ahmed: That's a great question, Scott. So when do you worry about it? And I'll kind of like answer this question two parts, right? So when do you worry about it? Let's say in the acute moment when it's happening, because there can be sometimes reasons why you would need to go to the ER or the bleeding could be a lot. So let's say if you tried pinching the nose for five minutes and, you know, the bleeding has not stopped and the child is profusely bleeding from the nose or even choking on the blood, you know, or gasping for air, those are not good signs. Definitely, we need to take a look a little deeper and figure out what's going on or where the bleeding is coming from. So those are situations where you would take the child to the ER, if there is choking, there's more serious bleeding,
And the other situation is when they're chronically bleeding, right? So they bleed once, but they constantly, let's say two or three times in the week, and for two to three weeks, they are constantly having these nosebleeds or recurrent nosebleeds, then you do want to go to the pediatrician or talk to them about it, because there could be other reasons why bleeding can happen and that's what your pediatrician would make sure that there's no underlying illness or any growth in the nose or anything which is causing all this bleeding.
One other common reason that we didn't cover is allergies. So if there are allergies and they're using some nasal medications, you know, sometimes if they're squirting medication inside the nose itself and causing some of those bleedings, that can also happen. But nonetheless, they should talk to their pediatrician about it if they're recurrent nosebleeds.
Scott Webb: Yeah. So you mentioned there, doctor, like there may be times when a nosebleed is bad enough to go to the ED or, if it's chronic, we should at least reach out to the pediatrician. But, you know, knowing children and you have children, I have children, kids don't always cooperate. Like sometimes they have issues like a nosebleed after hours and maybe it doesn't quite rise to the level to go to the emergency department and we're sort of caught in between, there is some after-hours care available, right?
Dr. Amina Ahmed: Yes. Yes. And, you're right, Scott. We do have an after-hours program, a virtual clinic that runs from 6:00 PM until 9:30 PM. And this is exactly why we are there to help you out. So in those situations where you're not sure what to do, you know, should you be rushing to the ER? Is it bad enough or not? So we do have the virtual clinic. It's like a telehealth. And so you can go to the website, like, after hours, stanfordchildrens.org and schedule the child in. And one of us, one of the Stanford pediatricians, we staff those clinics. So we will be there and we're more than happy to talk to you and go over questions if the nosebleed is severe enough, if it can be managed at home, can it wait until the morning or do you need to go to the ER? So yeah, we'll go over all those questions with you.
Scott Webb: Yeah. You know, we've talked about remaining calm and sort of not wanting to freak our kids out. How can we sort of address things with them? How do we explain nosebleeds? How can we prevent them? And mainly, how can we, you know, prepare them so that they don't freak out?
Dr. Amina Ahmed: Kids learn from us, you know, and there are great opportunities to talk about it. You know, it's a common thing and we do a little treatment like you pinch the nose and kind of prepare them for it. So those little kind of incidental events that happen in life, they are good teaching opportunities that kids can learn from. There's nothing scary. If it does happen, what to do next, to pinch their nose if a friend has it or they have it, and then seek help from an adult. And it could happen because of just a little bit of dryness in the nose, et cetera. So the kids can stay calm about it and they don't worry that something major is happening.
The other thing is how to prevent it. If this is happening because of dryness, then you could always use some over-the-counter nasal saline drops in the nose. They use them daily. Put one or two drops on each side to help moisten the mucosa and prevent any dryness and bleeding from the dryness in the nose.
Another thing is to use a humidifier, you know, in the house. If you have had the heating on or you know that the air is very dry. In California, deceptively dry. So it's good to kind of keep that humidifier next to their bed and it'll help kind of moisten the air and the nasal mucosa.
Scott Webb: Yeah, good stuff today. A lot of fun, a lot of education here. And doctor, as we wrap up, you know, we prefaced by saying nosebleeds are common and we have a pretty good sense of why our children get them and how we can stop them. But what would be your takeaways for parents, whether it's about remaining calm or anything else?
Dr. Amina Ahmed: First and foremost, like you mentioned, I would emphasize staying calm. And even I'm a parent and a pediatrician myself, I have to remind myself of that too, you know? Because when it comes to your child, you know, it's natural to feel anxious. So, one is to stay calm. Remind yourself, I'm going to go step by step through this and we'll figure out what's going on.
The other is kind of look out for worrisome signs, the things that we've talked about. You know, if your child doesn't look good, if they're choking on the blood, if there's a lot of bleeding or bleeding from other areas in the body, the bleeding in their gums as well, or they have rashes on their body or bruises on their body, those are all worrisome signs, so do talk to your pediatrician about it. And we're here to help. And if you're anxious about it at all, like you mentioned, have a telehealth, you know, if you don't want to come in. But at least get information from us, get the right information. And we're more than happy to tell you what to do, go over history and talk about if there are any worrisome signs that need further workup.
Scott Webb: Yeah. Well, that's perfect. And I've said it before, and I'll say it again on these podcasts, you know, pediatricians are just the best. Just knowing what the latest options are, the latest treatment and all of that is so good to hear from you. So thanks so much and you stay well.
Dr. Amina Ahmed: Thank you so much. It was a pleasure talking to you.
Scott Webb: And for more information, visit stanfordchildrens.org.
And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.