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CHILD’S NOSE BLEEDING
Nosebleeds in children are very unhappy and worrying situations for parents. Unlike any disease that happens to their son, the presence of bleeding leads to panic in the family. But most nosebleeds are mild bleeds and can be easily controlled due to the fact that they originate from places near the nasal entrance. Despite this, it should be known that severe bleeding may also be life-threatening and that it is necessary to intervene without wasting time. Before going into detail about nosebleeds, some information about the nose will be useful.
Our nose is one of the most blood-drawn organs of the body. The turbinates and mucous membrane play a role in the functions of heating, humidifying and cleansing the air taken from the nose. Conchas are popularly known as nasal decussations; they have the characteristics of swelling and stroke with an increase or decrease in blood circulation. In this way, our nostrils are clogged and opened in turn, and they ensure the functioning of the nose. The mucous membrane covers the concha and the entire nasal cavity. A gel-like mucus layer is located on the mucous membrane and provides moisture protection in the nose, prevents the nose from drying out. Just as our skin bleeds when it is grazed or damaged, nosebleeds also occur when the mucous membrane is damaged. Basically, conditions such as hot-dry weather, infections and nasal stirring disrupt the durability of the mucous membrane, causing capillaries to open and thus opening a role for bleeding.
How can we tell if the bleeding is serious or not?
It is useful to have a general idea about nosebleeds, most of which are due to simple causes, and to know what can be done during bleeding. It is possible to examine nosebleeds under two headings according to their severity and the place where they originate:
Anterior nosebleeds: Just at the entrance to the nasal cavity, on the middle line, the capillaries come together in a special area inside the mucous membrane (Kisselbach’s plexus or Little’s area). Decongestant nasal bleeding occurs in the middle of the nose. The most common nosebleeds in children are those belonging to this region. Most nosebleeds become unilateral due to the cracking of a capillary vessel here. Since the veins in this area are quite thin and on the surface, they can bleed with a nasal blow, a small fingernail touch, or even a light blow. When bleeding in this way, there is usually a small amount of bleeding from the nose outward while sitting or standing. The amount of bleeding may be excessive in some cases, but even these can often be controlled by finger pressure. They are often seen in children and young adults.
Posterior nosebleeds: They can be difficult to control and serious bleeding. In addition to head injuries and facial injuries, they are actually often seen in those of middle and advanced age, those with blood pressure problems. In children, on the other hand, they can occur in those who have bleeding-clotting problems. Because they originate from the posterior upper regions inside our nose, finger pressure applied to the front of the nose does not stop the bleeding here. Bleeding continues towards the mouth and throat. Bleeding in this area requires the intervention of an absolute ENT specialist, it may even require the support of branches such as Internal Medicine-Hematology and Interventional Radiology. If there are also signs of excessive blood loss, such as darkening of the eyes, feeling unwell, palpitations, blood pressure drop and pulse acceleration, the way to the hospital should be urgently kept.
What are the main causes of nosebleeds?
Nosebleeds often occur in dry-hot summer or winter months due to the drying of the nasal mucosa due to the room air dried by heaters. It leads to drying, crusting, the capillaries crack and bleeding begins. Again, sometimes it can develop due to the wear and tear of the mucous membrane in upper respiratory tract infections such as colds, flu or sinusitis. In addition, drug use or diseases that can lead to bleeding-clotting disorders can cause nosebleeds. To put it in terms of substances, in general:
- Mixing the nose in cases of allergies, infections or dryness that lead to itching,
- Strong nasal blowing leads to cracking of the nasal capillaries, leading to,
- Bleeding-those with a clotting disorder or the use of aspirin and similar medications,
- Liver diseases, high blood pressure,
- Nasal curvatures,
- Serious conditions such as nose fractures, head and facial injuries,
- Leukemia or some intranasal tumors, although they are quite rare,
They may be the cause of nosebleeds. One or more of these conditions may occur together, and this may determine the severity of the bleeding.
What to do to stop nosebleeds?
There are some methods that can be applied when a nosebleed is encountered:
An attempt should be made to calm the person who is bleeding. The blood pressure (blood pressure) of those who are excited and panicked increases, and the severity of bleeding may increase.
The head should be slightly tilted forward. Because when the head is thrown back, the blood goes from the nose to the nose and throat, and from here it is swallowed and goes to the stomach. The amount of bleeding is not understood, and it can also lead to nausea and vomiting. Again, for this purpose, blood should not be kept in the mouth, it should be spat out.
It should be compressed with the thumb and index fingers in such a way that it completely grasps the soft part of the nose. At the same time, it can be placed into the nose by wetting some cotton with any of the nasal opening sprays.
Firm, but gently squeezed with the side of the head and index fingers, the soft parts of the nose should be pressed against the face, towards the facial bones.
It should be waited in this way for about 5-10 minutes.
If a posterior nosebleed is suspected, where the bleeding is severe, the way to the hospital should be kept on the one hand.
If the patient has a blood pressure problem, it should be considered that he may have neglected his medications. If possible, blood pressure should be measured, if it is high, medications should be given.
If it is necessary to sit upright or lie down, it should definitely be laid in such a way that the head remains high. Thus, the bleeding area is higher than the heart level and the severity of bleeding can be reduced.
Ice can be applied to the nose and cheeks at this stage.
If the bleeding has stopped and the nose is open, an attempt should be made to breathe slowly through the nose.
When should I consult a doctor?
- Nosebleeds that do not stop or recur.
- There is also bleeding from other places besides the nose, for example by urination and defecation.
- The presence of bruising and bruises on the body even with light blows.
- Aspirin, the use of blood-thinning drugs similar to Coumadin.
- Having diseases such as liver, kidney or hemophilia that can cause a clotting disorder.
- She has recently had chemotherapy.
- What is done in the hospital?
The location of bleeding is determined by endoscopic examination. Bleeding can be stopped by making a limited buffer or coagulating the capillary vessel with a small intervention in anterior nosebleeds where the bleeding does not stop. In case of repeated bleeding, anterior and/or posterior nasal tampons can be used to control bleeding for 2-4 days.
If bleeding-clotting disorder is considered, some blood tests may be performed.
If the bleeding has stopped on its own or does not bleed after the tampon is taken, softening and wound healing creams or nasal ointments are often recommended. These can be applied two to three times a day for up to 2 weeks, but usually one application before bedtime is sufficient. Saline physiological drops or sprays can also be used to moisturize the inside of the nose.
If the bleeding site cannot be determined during the endoscopic examination, or if there are suspicious appearances at the bleeding site, some radiological imaging methods may be used.
In case of severe bleeding and in the presence of blood loss, the patient can be supplemented with some blood products. With some surgical or interventional radiological applications, the vessel supplying the bleeding area can be found and controlled.
What can be done to prevent the recurrence of bleeding?
- The inside of the nose should be gently cleaned with sprays containing salt water.
- The nose should not be stirred and should not be snorted.
- Heavy activities should be avoided and weight should not be lifted.
- The head should be kept above the level of the heart.
- The current environment should be tried to be moistened.
- It should not be eaten hot and spicy.
- Do not take a bath with hot water, warm water should be preferred.
- Aspirin or anti-inflammatory drugs should not be taken, but if necessary, they should be changed by consulting a doctor.
- It should not be located in hot and dry environments, it should bring the ambient temperature and humidity to appropriate conditions.
Nosebleeds in children can often be managed without problems. The family’s being cool-headed can also help them to control the bleeding themselves, and it also makes it easier for the Otolaryngologist in Turkey to make the appropriate intervention to the child if necessary. In addition, some families can also wipe the inside of children’s noses with tissue paper. Avoiding this application prevents the mucosa in that area from losing its properties and may lead to drying and bleeding.
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Turkey's world-renowned organ transplant specialist. Dr. Demirbaş has 104 international publications and 102 national publications.
Physician's Resume:
Born on August 7, 1963 in Çorum, Prof. Dr. Alper Demirbaş has been continuing his work as the President of MedicalPark Antalya Hospital Organ Transplantation Center since 2008.
Prof. who performed the first tissue incompatible kidney transplant in Turkey, the first blood type incompatible kidney transplant, the first kidney-pancreas transplant program and the first cadaveric donor and live donor liver transplant in Antalya. Dr. As of August 2016, Alper Demirbaş has performed 4900 kidney transplants, 500 liver transplants and 95 pancreas transplants.
In addition to being the chairman of 6 national congresses, he has also been an invited speaker at 12 international and 65 national scientific congresses. Dr. Alper Demirbaş was married and the father of 1 girl and 1 boy.
Awards:
Eczacibasi Medical Award of 2002, Akdeniz University Service Award of 2005, Izder Medical Man of the Year Award of 2006, BÖHAK Medical Man of the Year Award of 2007, Sabah Mediterranean Newspaper Scientist of the Year Award of 2007, ANTIKAD Scientist of the Year Award of 2009, Social Ethics Association Award of 2010, Işık University Medical Man of the Year Award of 2015, VTV Antalya's Brand Value Award of 2015.
Certificates:
Doctor of Medicine Degree Hacettepe University Faculty of Medicine Ankara, General Surgeon Ministry of Health Turkey EKFMG (0-477-343-8), University of Miami School of Medicine Member of Multiple Organ Transplant, ASTS Multiorgan Transplant Scholarship. Lecturer at Kyoto University. Lecturer at University of Essen, Research assistant at the University of Cambridge .
Professional Members:
American Society of Transplant Surgeons, American Transplantation Society Nominated, Middle East and Southern Africa Council Transplantation Society 2007, International Liver Transplantation Association, Turkish Transplantation Association, Turkish Society of Surgery, Turkish Hepatobiliary Surgery Association.
Disclaimer:
Our website contents consist of articles approved by our Web and Medical Editorial Board with the contributions of our physicians. Our contents are prepared only for informational purposes for public benefit. Be sure to consult your doctor for diagnosis and treatment.