Dr. Jeremy Friedman, head of pediatric medicine at Sick Kids Hospital in Toronto, is shown in a handout photo. Friedman says blood vessels in the nose are close to the skin and bleed easily. "It's a relatively harmless, benign, self-limited problem," said Friedman. "The most important thing is not to panic." THE CANADIAN PRESS/HO"
TORONTO - When Irum Khan rushed into her daughter Amelia's room in the dead of the night to respond to her cries, she was alarmed to find blood running down the three-year-old's face.
A nosebleed turned out to be the culprit.
"It was like a waterfall — it wouldn't stop," recalled Khan.
At first she thought it might be a freak incident, but Khan became more concerned when Amelia had recurring nosebleeds over the next two days.
"I thought the worst things possible," said Khan.
Her worries were calmed by a trip to the pediatrician, who suggested waiting a few days to see if the bleeds would stop on their own. Two days later, Amelia's nosebleeds had disappeared.
Dr. Heather Jenkins, a family physician in Vancouver, says frequent nosebleeds are not uncommon.
"The business of having a cluster of nosebleeds points to the fact that the lining around your nose is having a challenge around healing," said Jenkins.
Dr. Jeremy Friedman, head of pediatric medicine at SickKids Hospital in Toronto agrees, adding that blood vessels in the nose are close to the skin and bleed easily.
"It's a relatively harmless, benign, self-limited problem," said Friedman. "The most important thing is not to panic."
The most effective way to stop a nosebleed is to apply pressure directly to the area by pinching the front of the nose with the index finger and thumb, and then leaning forward. Leaning back will also stop the nosebleed but will send blood into the back of the throat.
"Children often end up spitting (blood) out which they find frightening, " said Jenkins. "Or they end up swallowing it and sometimes that can upset their stomachs."
Friedman notes a common mistake parents make is to put pressure too high up the nose, on the "boney" part of it.
"If you put pressure there it does absolutely nothing," he said.
Another common mistake is not applying pressure to the area for long enough, said Friedman. Pressure should be applied ideally for five to 10 minutes. Ten minutes can feel like a long time while panicked, but Friedman advises not to keep checking every minute if the nosebleed has stopped — apply continuous pressure.
If pressure has been applied for upwards of 10 minutes and the bleed has not stopped, Friedman says to make preparations to head to the emergency room. And if nosebleeds are frequent, it's worth investigating the source of trauma that is triggering them.
"Number one is nose picking," Jenkins said, noting it's a reason why bleeds are so common in kids aged two to 10.
There are also seasonal explanations.
"I think a lot of the summertime nosebleeds are more related to kids with hay fever and allergies," said Friedman. "(Children) rubbing and picking their noses — it's a recipe for a nosebleed."
In winter, colds and dryness can often trigger bleeds.
Although it's natural for parents to worry at the sight of blood, nose bleeds are rarely a sign of something more serious, stressed Friedman.
Friedman does note a nosebleed in a child younger than two is "unusual" and may be reason to get the infant checked out.
Additionally, a prolonged nosebleed in younger and older children alike could be a sign of a bleeding disorder, such as hemophilia — a condition where blood does not clot normally.
"What would alert me to the possibility of that would be signs of other bleeding," said Friedman, adding that other signs could include bruises and bleeding from the gums.
But discovering a bleeding disorder as a result of a nosebleed is "rare," said Friedman.
"The most common cause for having a prolonged bleed is just a prolonged normal bleed — just a bigger vessel that's taking longer to stop," she said.
Targeting underlying issues can also aid prevention. For dryness during the winter months, Jenkins recommends a humidifier and also use of an ointment like Vaseline or Polysporin to moisturize the inside of the nose. And during allergy season, avoiding pollens is key.
"Showering before you hit the bed is a big one," she said. "Just rinsing off all the pollens."
Taking antihistamines to reduce allergy symptoms may also help, since reducing irritants to the nose such as sneezing may reduce the likelihood of a bleed.
And, to address the most common cause of nosebleeds, children need repeated reminders to keep their fingers out their noses along with plentiful access to tissues to encourage compliance.
Said Jenkins: "Kids have lots of fun exploring their bodies and certainly their nose is a fascinating thing."
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