What is the first aid for epistaxis in a child?

How to Control Nosebleed in a Child at Home

Position your child sitting upright with head tilted slightly forward, then pinch the soft lower part of the nose firmly for 10-15 minutes without checking if bleeding has stopped—this simple compression alone stops the vast majority of childhood nosebleeds. 1

Immediate First-Line Management

Proper Positioning

• Have the child sit upright with head tilted slightly forward to prevent blood from entering the airway or being swallowed 1, 2
• Instruct the child to breathe through their mouth and spit out any blood rather than swallowing it 1

Nasal Compression Technique

• Apply firm, continuous pressure by pinching the soft lower third of the nose (not the bony bridge) for at least 10-15 minutes 3, 1
• Do not release pressure to check if bleeding has stopped during this time—this is a critical error that prevents clot formation 1
• Compression alone is sufficient to stop bleeding in the majority of cases 3, 1

If Bleeding Persists After 15 Minutes

Topical Vasoconstrictor Application

• First clear any blood clots from the nose 1
• Apply a topical vasoconstrictor such as oxymetazoline (Afrin®) or phenylephrine nasal spray—2 sprays in the bleeding nostril 1, 2
• Resume firm compression for another 5-10 minutes 1
• This approach resolves 65-75% of nosebleeds that don't stop with compression alone 1

Prevention of Recurrence

Nasal Moisture Maintenance

• Once bleeding stops, apply petroleum jelly (Vaseline®) inside the nostrils to keep the nasal lining moist 1, 2
• Use saline nasal sprays regularly to prevent dryness 1, 2
• Consider using a humidifier, especially in dry environments or during winter months 1

Common Pitfalls to Avoid

Critical errors that reduce effectiveness:

• Tilting the head backward—this causes blood to flow down the throat and can lead to choking or vomiting 1
• Insufficient compression time—checking too early disrupts clot formation 1
• Inserting tissues or cotton into the nostrils—this can traumatize the tissue further when removed 1
• Applying ice or cold compresses directly on the nose—this is not effective 1

When to Seek Medical Attention

Go to the emergency department or call for medical help if: 1

• Bleeding does not stop after 15 minutes of continuous proper compression
• The child experiences dizziness, weakness, or lightheadedness (signs of significant blood loss)
• The child has a known bleeding disorder or takes anticoagulant medications
• The child is under 3 years of age (may require different management approaches) 1

Special Considerations

Children on Anticoagulants

• Even if bleeding stops with home measures, these children should be evaluated by a healthcare professional 1
• If medical treatment becomes necessary, resorbable packing materials are preferred over traditional packing 3

Age-Specific Notes

• Nosebleeds are extremely common in childhood, with 3 out of 4 children experiencing at least one episode 3
• The average age of presentation is 7.5 years, with boys affected slightly more often than girls 3, 4
• Most childhood nosebleeds originate from the anterior (front) part of the nose and are self-limiting 4, 5