Nosebleeds (epistaxis) are a common childhood condition. They are usually self-limiting and children normally grow out of them by around 11 years of age.
They are commonly caused by minor injury to the lining of the nose and this can happen by picking or banging the nose. They can also occur if your child:
- has had a recent cough / runny nose (viral upper respiratory tract infection)
- has allergic rhinitis
- blows their nose too hard
- has a very dry nasal passage
- has an object stuck in their nose
Only very rarely can nosebleeds be due to a bleeding disorder.
The bleeding is usually from the front part of the nose and while the amount of blood may seem like a lot (such as soaking through tissues), it is rare for children to lose so much blood that it causes any problems (such as anaemia). This is only likely with frequent, heavy nosebleeds over several weeks or months.
The advice below should help you decide whether your child’s nosebleed requires further help or whether it can be managed by yourself at home.
Check if your child has any red symptoms:
- Your child is on medication that prevents blood clotting (such as warfarin, heparin or aspirin).
- Nosebleed has been ongoing for more than 20 minutes despite appropriate first aid.
- Bleeding from both nostrils (this suggests a nosebleed from the back of the nasal passageway).
- Your child is choking on the blood despite sitting upright and leaning forward (this suggests a nosebleed from the back of the nasal passageway).
- Significant disfigurement to their nose after injury to the face.
- Any difficulty breathing.
- A condition that means their blood cannot clot properly, such as haemophilia.
Actions to take if your child has any red symptoms
- Your child may require emergency treatment.
- You should call 999 or take them to your NEAREST Emergency Department where they can be assessed.
If there are no red symptoms, check if your child has any amber symptoms:
- Discharge from the nose alongside the nosebleed (this may be due to an object in the nose).
- Frequent small volume nosebleeds that respond to first aid.
- Nosebleeds and bruised skin anywhere on the body or a family history of a bleeding disorder.
Options if your child has any amber symptoms
Your child does not need to be taken to the Emergency Department immediately, but you should seek medical advice today.
- ring your GP surgery during their usual opening hours
- contact the out of hours GP if the surgery is closed
If symptoms continue for four hours or more and you have not been able to speak to your GP or the out of hours GP, consider going to your nearest Emergency Department.
If your child develops any of the red symptoms above, go to your nearest Emergency Department.
If your child continues to get frequent nosebleeds, please arrange to speak to your GP or practice nurse.
If no red or amber symptoms are present:
- your child does not seem to have any symptoms of serious illness or injury
- you can get general advice on the NI Direct website or from your local pharmacy
If your child develops any of the red or amber symptoms above, follow the advice in these sections.
- Apply continuous pressure for at least 10 minutes to the fleshy front part of the nose by pinching it between your index finger and thumb. Keep your child sitting up and leaning forward, breathing through their mouth. It may be easier to place younger children on your knee facing outwards. Encourage them not to swallow the blood but instead to spit it out, as swallowing blood can cause them to vomit, which can then trigger the nosebleed to restart.
- Keep talking to your child with reassurance and keep them as calm as possible. It is tempting to release the pressure from the nose to check if the bleeding has stopped, but don’t do this until the 10 minutes are up, as this could prevent a clot from forming. If there is an ice pack available, this can be placed on their forehead or the nape of their neck.
- Giving them a cool drink can also help them cool down.
- If there is ongoing bleeding after 10 minutes, check that the position of the pressure being applied is correct and apply pressure for a further 10 minutes.
- If there is still ongoing bleeding after the further 10 minutes, you should immediately attend your nearest Emergency Department or call an ambulance. Stay calm and continue to apply pressure to the front part of the nose until they arrive.
- The Red Cross has some excellent advice and videos on how to stop a nosebleed in a child.
After the nosebleed
If the bleeding has stopped by following the first aid measures, for the next 24 hours your child should be advised:
- not to pick or blow their nose
- stick to restful and quiet activities (such as reading or drawing)
- avoid hot baths, showers and warm drinks
To prevent future nosebleeds
- If your child’s nose is dry and cracked, apply a petroleum-based jelly (for example Vaseline) to the nostrils, generally twice a day for a week. This can be done using a cotton tip or finger, and gently rubbing it on the inside of the nose. Do not use this method in children under four years of age as they are unlikely to cooperate or sit still, and their nose may be injured.
- If your child is suffering from constipation, increase their fluid intake and the amount of fibre in their diet, or ask your doctor or pharmacist for a stool softener to prevent them from straining.
- If it is non-urgent, speak to your local pharmacist or health visitor.
- Alternatively, you can contact your GP practice and a qualified member of the clinical team will check whether your child needs to be seen urgently. Out of hours GP details are available here.
- You should only call 999 or go your nearest Emergency Department in critical or life-threatening situations.
- See our section: How does the Children’s Emergency Department Work?