Anatomy of Nose Bleeds in Children

I have been seeing my recurrent and chronic nose-bleeders in clinic again. It goes with the season. Now that we are in the cold-weather, heat-is-on-air-is-dry season, you are bringing your children with nose bleeds to see me in clinic again. So I thought now would be a good time to review nose bleeds (epistaxis) in children.

Can you say rhinotillexis? Yes, that’s “nose-picking,” something that children are twice as likely to do compared to adults (yes, believe it or not, someone studied this). With the exception of the elderly (who are often on multiple medications and have health problems that can affect blood clotting), children are about twice as likely to experience nose bleeds as adults are. Children are also about twice as likely to pick their noses. Coincidence?

Anatomy of Nose Bleeds in Children

Nose bleeds occur frequently in children, but are fortunately less likely to pose a serious threat than in adults. There are several blood vessels that supply the lining of the nose. As the lining becomes dry, as is more likely to occur during the winter months, it can crack, and these vessels can bleed.

The vessels that bleed in children lie in the covering of the anterior nasal septum – the midline structure that divides the nose into the right and left sides – in an area called Kiesselbach’s plexus, or Little’s Area (there will be a quiz later). This means that most nose bleeds are in the anterior, front part of the septum.

What I see in clinic mostly are nose bleeds that are the result of some combination of dry air, nose-picking, and perhaps some additional cause of irritation such as allergic rhinitis. Although trauma (getting hit in the nose by a baseball, for example) is a common cause of nose bleeds in children, it is unusual for trauma to result in recurrent and chronic nose bleeds. That is, the bleeding is limited to the time of the injury, and does not become a recurring problem once the injury has healed.

Bleeding from the anterior part of the nose means that our little nose-pickers slightly injure these vessels while “exploring” their noses, with resulting epistaxis. During the very driest months of winter or summer, even gently blowing the nose can result in significant bleeding.  What to do? …

Next time, How to Control Your Child’s Nose Bleeds

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