Under Pressure

Today’s guest columnist is Dr. Jeremy White, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

“Not the table!” I shrieked, peering through my fingers at the slow-motion tragedy unfolding before me. It was my first night ever babysitting, for some family friends’ two-year old daughter. Mom and Dad had no sooner backed out the driveway for their night out, before WHAM!  Gracie had tripped and smacked her petite nose on the sturdy dining table. She didn’t cry at first, even giggled a little, until she saw blood on her hands.  Deep gasp….

Parents, kids, and even babysitters sometimes panic when they see bleeding. They can get frantic: when will it stop, that’s so much blood!, can my child breathe? Often the kid has smeared blood all over his face and clothes like a horror-movie victim, increasing everyone’s anxiety. Then when they get to the Emergency Department, most times the bleeding has stopped.

Many nosebleeds result from injuries: football passes gone awry, wrestling matches, or that pesky furniture that “leaps out” at toddlers. No matter how it happens, the mainstay of treatment of any bleeding is applied pressure. For nosebleeds, that means pinching the nostrils closed for 10 minutes. You don’t have to squeeze hard, gentle pressure is enough.

Often we anxiously check too soon to see if the bleeding has stopped, letting go of the nose to have a look. This isn’t really applying pressure. When we say pressure for 10 minutes, we mean 10 minutes on the clock, without letting go to check. Another common mistake is tilting the head back. This doesn’t help stop bleeding; it only allows blood to trickle down the back of the throat, leading to coughing, gagging, and nausea.

When do we need to take kids to a doctor?  Come in If the nose is obviously broken- crooked or dramatically swollen. If the child is in a lot of pain, or the bleeding just won’t stop after multiple attempts of 10 minutes of steady pressure, that should be seen. However, don’t panic. We’ve never ever had a child die of nose bleeds.  Apply pressure, don’t succumb to it!

I’ve been on several annual retreats to the Rocky Mountains with students from my old high school. When we would get off the bus at our destination, some kids would climb down with blood coming from their nostrils. One year six students got bloody noses!  Between the high-altitude thin air and super-low humidity, some kids’ noses just let go.

When kids breathe cold dry air, the inside of their noses gets dried out and can crack. Sometimes those cracks cut into blood vessels and POW!- bloody nose. This explains why we see nose bleeds so much in August, after we’ve been living in air conditioning all summer. That water you see dripping out of an air-conditioner is the moisture sucked out of the indoor atmosphere.

We also see lots of nosebleeds in the winter, when the air’s naturally cold and dry. Kids get more head colds in winter too. When excess snot from those spewing noses dries out and cracks, nasal blood vessels crack too. If your child has frequent nosebleeds, a bedside humidifier can keep nasal passages moist at night, when the air is driest. For allergic kids who aren’t supposed to use vaporizers (they can be mold-growers), saline nasal spray is another option.

Some children have extra-fragile blood vessels in their noses. With repeated bleeds, they get raw patches that don’t heal well. If your child has nosebleeds that keep recurring, then it’s time to see an Ear/Nose/Throat (ENT) specialist. The ENT has skinny scopes for looking inside noses and finding those raw spots. If necessary, the bad patches can be cauterized.

As we said above, children never lose a significant amount of blood, though parents sometimes panic when the kid paints his face, pajamas, and bedroom red. However, it always looks worse than it is. When a child is actively bleeding, gently squeeze the nostrils shut for 10 minutes on the clock, with no letting go during that time to check if it’s stopped. Again, no head tilting back either.  Don’t panic- as we also said above, apply pressure, don’t succumb to it!

Junior Springs A Leak

This week’s guest columnist is Dr. Chad Mathews, a Family Practice resident at the University Hospital and Clinics here in Lafayette.

Kids get a lot of bloody noses. While they’re usually only a mild inconvenience, nosebleeds freak out some parents.  They get alarmed at the blood- it looks like a lot! However, kids rarely lose a worrisome amount of blood. Another myth about kid nosebleeds: they are caused by high blood pressure, and are a harbinger of complications like stroke.  Finally, kids don’t choke to death on blood trickling down their throats.

Many nosebleeds seen in the Emergency Department are from minor injuries- bumps on the nose from balls and siblings, and nose picking.  Nosebleeds also happen in dry climates, because of allergies and colds, and because of some medications.  While dry climate is not a Louisiana issue, air-conditioning removes humidity, causing dryness indoors.  However, allergies are common here, and with that comes allergy medication. Allergies make for runny noses, then allergy medicines dry out the nose and mucus.  The dried-out inside of the nose and mucus get cracked, a crack runs through a vein, and pow!

Regardless of cause, the initial treatment for nosebleeds is the same.  Apply pressure to stop bleeding and allow clotting.  Applying pressure means gently pinching the nostrils together without causing pain.  We have all been told growing up to lean the head back. This does very little to stop the bleeding, but very effectively causes blood to drain down the back of the throat.  While saving her shirt from blood stains, for the kid it only leads to gagging and coughing and nausea.

Gently squeeze the nostrils closed for ten minutes.  It takes that long to make a clot. Don’t keep checking to see if the bleeding is done during that time: letting go interrupts the clotting process.  Hold for the whole time, watching a clock.  Sometimes when parents let go and bleeding continues, they really get nervous.  Don’t panic!  Again, no kids bleed to death from nosebleeds. Close the nostrils for another ten minutes and hang on. Sometimes a few drops of Afrin help slow bleeding.

Injuries cause lots of nosebleeds, besides dry noses and allergies that we discussed above.  Misplaced elbows, thrown toys, a wall that leaps in your child’s way, all these cause bloody noses.  Then there’s many children’s favorite pasttime- picking (many adults enjoy this too).  Nose picking is a double whammy on nose tissue.  It often starts with itchy noses from allergy and dry air. Then when your kid scratches that itch, his fingernail tears the already dried out, cracked, and fragile tissue, nicks a vein, and it’s off to the races.

Like we said, stopping nosebleeds is usually easy.  Squeeze the nostrils closed gently for ten minutes, not letting go to check if it’s stopped until time is up.  If that doesn’t work, do it again.  But what if after all that your kid’s nose is still bleeding and you’re out of decorative dishtowels, and your furniture and carpet look like a Jackson Pollock nightmare?

If the bleeding won’t stop after a couple of tries at direct pressure, then it may be time to bring your child in.  Another issue is if an injury caused the bleeding, should the nose be looked at for other problems besides the bleeding itself?  If there is a large amount of swelling around the bridge of the nose, or every time you touch your kid’s nose they pull away and let out a howl, then maybe it should be looked at.

After a nosebleed, there are often some “aftershocks” of bleeding.  If nosebleeds are recurrent you might put a humidifier in the bedroom, and run the air conditioning less.  If bleeding continues on and off for more than a week, it’s time to see an Ear/Nose/Throat (ENT) specialist.  Sometimes kids get a raw spot inside their noses that just won’t heal, and the ENTs have the tiny scopes to look inside, find the raw spot, and cauterize it.

All in all nosebleeds are a side effect of growing up.  They are rarely dangerous, and cause more alarm than real trouble.  Remember not to panic, and you can always call the people who are trained to help when you are concerned.

Do Nosebleeds Really Come From Cheap Seats At The Cajundome?

Today’s guest columnist is Dr. Adam Giddings, a second-year resident in Family Practice at the LSU-University Health Center program here in Lafayette.

Seeing your child with a nosebleed can be a very traumatic image.  While it may appear that he or she is losing a gallon of bright red blood, a nosebleed is often harmless and easily controlled.

Nosebleeds may occur periodically in your child’s life.  They can happen at any age, but are most common in children ages 2-10.  After reading this article you should be confident in your ability to handle nosebleeds at home and know the warning signs to see a doctor.

Cause of Nosebleeds

There are several possibilities why your child has a nosebleed.  Here are the most common causes:

-Dry Climate: When your child is exposed to dry air, whether indoors or outdoors, this causes the inside of the nose to dry out.  The dry air leads to cracking in the nose, and those cracks can go through a blood vessel and cause a bleed.

-Common Cold & Allergies: If your child has a cold, the lining of the nose may get irritated and bleed, especially after repeat blowing of the nose.  If your child has allergies and is using antihistamines or decongestants to control symptoms, these may further dry the nose and lead to bleeding.

-Nose Injury: Another common reason for a nosebleed are injuries.  A blow to the nose may cause bleeding; however, this usually isn’t a concern as long as the bleeding stops in 10 minutes.

Treatment of Nosebleeds

Although it may initially be scary for both you and the child, there is no need to panic.  Follow these tips for stopping a nosebleed.

-Use soft tissues or a damp cloth to catch the blood.  Do not let your child blow their nose, as it may cause more bleeding.

-Have your child sit up and lean forward.  Sitting forward will help prevent any gagging on blood going from the back of the nose to the throat.  Myth buster: children do not choke to death on dried blood in the throat.  Gagging on blood and nose bleeds during sleep are no fun, but not life-threatening.

-Pinch the nostrils closed just below the bony center to stop bleeding.  With steady but gentle pressure, the bleeding should stop in 5 to 10 minutes.  You don’t have to pinch so hard it hurts.  Steady pressure means don’t continually let go and check if the bleeding is stopped.  Keep the pinch on for the whole 5 minutes, without interruption!

-To prevent re-bleeding, do not allow any nose picking or blowing for several hours after.

When to seek Medical Attention

-If bleeding continues after a third or fourth attempt to stop it, you may want to see a doctor.  Life-threatening bleeding almost never happens, but no one wants to walk around with a bleeding nose either.

-See a doctor if your child starts to feel dizzy or light-headed, has a fast heartbeat, is coughing up or vomiting blood, or has a fever.

-If your child has nosebleeds frequently- more than once per month- or has been having them for years, see your doctor.  Your child may have a raw spot that just won’t heal, and need an Ears/Nose/Throat specialist to cauterize that bad patch.  Your kid may also need blood tests to be sure he does not have a rare disorder with making blood clots, like hemophilia.

Preventing Nosebleeds

Although it may be hard to always prevent a nosebleed, below are some simple steps to insure your child doesn’t have them a lot.

-When your child is blowing her nose, make sure she is blowing gently.

-Teach you child to keep the mouth open when sneezing.

-Like we said above, dry air makes bleeding easier.  Air-conditioning dries the air, and the colder it is, the drier.  Turn your A/C more towards 75 degrees, rather than below 70.  Cold winter air is drying, indoors and out, especially at night.  A vaporizer or humidifier at your kid’s bedside can provide moisture to keep the inside of the nose from cracking and bleeding.  A lubricant or saline drops may also be helpful.

Remember, it is important to stay calm, as most nosebleeds can be managed at home with the simple steps above.  An occasional nose bleed is not worrisome, and there’s no need to panic.  Now you know what to do!