Nose bleeds in children are common.In nine out of ten cases its due to nose picking.It’s the rest which we need to rule out.
What you should do if your child has nose bleed?
1)Don’t panic.Seeing you panic or cry will scare your child scared and he/she will start to cry.This can cause the nose bleed to become worse.
2)Pinch the nose and ask child to breathe gently through the mouth.Child should be bending forward over a wash basin ,or you can hold a vessel in front of his mouth .
3)Talk to the child gently and calm him down.
4)You can then hold a cold damp cloth over the nose bridge.This helps control bleeding too.Pinching the nose helps stop bleeding within 5 to 10 minutes.
When should you worry and visit your nearest emergency?
1)If the bleeding happens for longer than 10 minutes.
2)Happens frequently and takes a long time to stop .
3)Bleeding also from other places ,like from gums,while peeing etc.
4)Baby is very pale and blood tests show hemoglobin to be low .
5)Even minor cut injury ,takes a long time to stop.
6)There is history of swelling of knee and other parts of body with discolouration even with minor trauma.
7)When bleeding causes baby to become lethargic.
8)There’s family history of similar bleeding.
9) There’s family history of consanguinous marriage.
10.Preconceptional testing not done for Thalassemia.
11.Family history of Thalassemia trait in one parent and other not tested.
What tests will your doctor suggest?
If its the first episode and bleeding stopped quickly few tests may be suggested depending on history and clinical examination
But if the doctor has grounds for clinical suspicion ,a thorough checkup may be needed.Nasal bleeding can sometimes be a danger sign of bleeding problems like, Thalessemia,Haemophilia and Leaukemia and other bleeding disorders.
A complete blood work up like:
- Haemoglobin
- Complete blood counts
- Platelet levels
- Prothrombin time
- APTT(Activated partial thromboplastin time)
- Liver function test
- Peripheral blood smear
- Haemoglobin electrophoresis to rule out Thalessemia
Radiology can be suggested keeping in mind history and clinical features. CTPNS (Computed tomography Paranasal sinus) helps rule out nasal masses.
If nose bleeding is due to trauma, it will stop with the first steps explained.After that nose drops ,oral antibiotics and topical antibiotic creams will be prescribed.One of the commonest preventable cause of nose bleeding in children is Thalessemia.
This prevention happens through blood tests done before marriage or atleast before planning to have a baby(preconception test).
Even now with massive awareness around this disease,there is multiple examples of Thalassemia baby ,especially in Eastern part of India
Data
Every year 10,000 to 15000 babies are born with Beta Thalassemia major in India.
India
1.5% of Global population are Beta Thalassemia carriers.60,000 new symptomatic patients every year make this a cause for concern.
Thalassemia Screening is crucial
High prevalence of Thalassemia in the Indian subcontinent.Carrier state high and often goes undiagnosed because it’s remains asymptomatic except for anemia .
Awareness about pre-marital counseling and tests – for all couples should be mandatory to avoid unfortunate problems.
For arranged marriages its highly adviced to avoid marriage between two individuals with Thalassemia trait.High risk of Thalassemia Major babies in couples with carrier state in both parents.
Nose bleeds in kids :3 Things you must know
Management of Pediatric epistaxis:Scientific Paper
Juvenile Nasopharyngeal Angiofibroma
Previously published on mycity4kids
