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.