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

First Aid Management for Pediatric Nosebleeds (Epistaxis)

For pediatric nosebleeds, the child should sit with their head slightly forward and have the soft lower portion of the nose pinched continuously for 10-15 minutes without checking if bleeding has stopped. 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 10-15 minutes without checking if bleeding has stopped 1, 2
• Compression alone is sufficient to stop bleeding in the vast majority of cases 1, 2

If Bleeding Persists

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

Prevention of Recurrence

• Apply moisturizing or lubricating agents such as petroleum jelly to the nasal mucosa to prevent recurrence 2, 3
• Use saline nasal sprays regularly to keep the nasal mucosa moist 2, 3
• Consider using a humidifier, especially in dry environments 2, 4

When to Seek Medical Attention

• If bleeding does not stop after 15 minutes of continuous pressure 1, 2
• If the child experiences dizziness, weakness, or lightheadedness 1, 2
• If the child has a history of bleeding disorders or is taking anticoagulant medications 1, 2
• If the nosebleed is due to trauma and the child shows signs of brain injury, obvious nasal deformity, or signs of facial fracture 1

Common Pitfalls to Avoid

• Insufficient compression time (less than 10-15 minutes) 1, 2
• Tilting the head backward, which can cause blood to flow into the throat 2
• Using ice or cold compresses directly on the nose (usefulness is unknown) 1
• Inserting tissues or cotton into the nostrils 2
• Frequently checking if bleeding has stopped, which can disrupt clot formation 2

Age-Specific Considerations

• Most pediatric nosebleeds occur in children under 10 years of age, with an average age of 7.5 years 1
• Children under 3 years of age may require different management approaches as guidelines are primarily focused on older children 2
• Nasal obstruction (nasal discharge) is the most commonly associated symptom (46%) in children with epistaxis 5
• Anterior nosebleeds are the most common type in children, usually originating from the anterior septum 6, 7
• Common causes in children include nasal dryness, digital trauma (nose picking), and nasal colonization with Staphylococcus aureus 7