What is the first aid management for a pediatric nosebleed (epistaxis)?

First Aid Management for Pediatric Nosebleeds (Epistaxis)

The first aid management for pediatric nosebleeds involves having the child sit upright with head tilted slightly forward and applying firm continuous pressure to the soft lower part of the nose for 10-15 minutes. 1, 2

Initial Management

• Position the child in a sitting position with head tilted slightly forward to prevent blood from entering the airway or stomach 1, 2
• Have the child breathe through the mouth and spit out any blood rather than swallowing it 2
• Apply firm, continuous pressure by pinching the soft lower third of the nose for at least 5 minutes, preferably 10-15 minutes without checking if bleeding has stopped 1, 2
• Compression alone is sufficient to stop bleeding in the majority of cases 1, 2

If Bleeding Persists

• Clear any blood clots from the nose 3
• Apply a topical vasoconstrictor such as oxymetazoline or phenylephrine (2 sprays in the bleeding nostril) 3, 1
• Continue compression for another 5 minutes 3
• This approach resolves 65-75% of nosebleeds that present for medical attention 1, 4

Prevention of Recurrence

• Once bleeding stops, apply moisturizing or lubricating agents such as petroleum jelly to prevent recurrence 1, 5
• Recommend regular use of saline nasal sprays to keep the nasal mucosa moist 5, 2
• Consider using a humidifier, especially in dry environments 5, 3
• Educate about avoiding digital trauma (nose picking) and vigorous nose blowing 1, 6

When to Seek Medical Attention

• If bleeding does not stop after 15 minutes of continuous pressure 3
• If the child experiences dizziness, weakness, or lightheadedness 1
• If bleeding is severe (duration >30 minutes over a 24-hour period) 3
• If the child has a history of bleeding disorders or is taking anticoagulant medications 1
• If there are signs of facial trauma, nasal deformity, or brain injury 1

Common Pitfalls to Avoid

• Insufficient compression time - compression should be maintained continuously without checking if bleeding has stopped 2
• Tilting the head backward, which can cause blood to flow down the throat 1
• Using ice or cold compresses directly on the nose - the usefulness of cryotherapy for epistaxis is unknown 1
• Inserting tissues or cotton into the nostrils, which can cause further trauma when removed 1

Special Considerations

• For children with recurrent nosebleeds, evaluation for underlying causes may be necessary 7
• Children under 3 years of age may require different management approaches as guidelines are primarily focused on children 3 years and older 1
• Children taking anticoagulant medications should be evaluated by a healthcare professional even if bleeding stops 1