Nosebleed | 5 most common reasons – Part 1/3

Nosebleed is alarming. It is an emergency situation for which you need to see an ENT doctor near you at the earliest. It affects children, adults and the elderly. Reasons for each being different, Let’s discuss children’s nosebleeds first. 

Nosebleed in child
A boy with bleeding nose

5 most common reasons for nosebleed in children are listed below:

1. Trauma: 

Fingernail trauma is the most common reason for nosebleeds in children. The columellar vein is a small vein located near the tip of the nose that is prone to injury due to nose-picking. The bleed is profuse and recurrent due to repeated pricking – crusting – drying – itch cycle. Taking a few simple steps like trimming fingernails, avoiding nose picking and applying petroleum jelly/antibiotic ointment to the affected will reduce the chances of a rebleed.

In older children, blunt force trauma such as a punch to the nose or a cricket ball to the nose is another reason for nosebleeds.

2. Infection:

Frequent nose blowing and sniffing seen in URTI (i.e. cold and sinusitis) cause mucosal trauma and bleeding. The child presents with mucous streaked with blood. Sinonasal infection can give rise to fleshy growth known as antrochoanal polyps. The main symptom the child presents with is nose block which occasionally may bleed due to drying and crusting. More commonly seen in vascular polyps known as angiomatous polyps. These conditions require prompt treatment.

3. Foreign body: 

Children often insert small objects such as peanuts, beans, plastic buttons, button cells or small toys up their nostrils. These foreign bodies cause trauma to the nose and bleeding. Sometimes this may go unnoticed by the parents and the foreign body migrates. The child develops chronic obstruction of the nose with frequent nosebleeds. An endoscopy of the nose will diagnose such cases. Removal of foreign body resolves the issue.

4. Tumours: 

Juvenile Nasopharyngeal Angiofibroma(JNA) are benign tumours that are aggressive, locally destructive tumours that bleed a lot. These are common in young boys. The nosebleeds are unprovoked, profuse and cause anaemia in the child. JNA tumours are surgically treated which, stops the bleeding.

5. Bleeding disorders:

von Willebrand disease (VWD) is a rare cause of nasal bleeding in children. A faulty gene inherited from the parents manifests as bleeding from various mucous linings such as the nose and gums. 

This article was written by Dr Akanksha Saxena, Consultant ENT, Head & Neck Surgeon, ENT360. She is a practising ENT Specialist in Gurgaon with over 10 years of experience. Read more of her blogs here.

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