Red flags & when to go in person for Nosebleed (Epistaxis) - Triage

Audience: pediatric

Nosebleeds, or epistaxis, are common in children and often happen due to dry air, minor injuries, or nose picking. Most nosebleeds stop on their own or with simple first aid at home. However, some nosebleeds may signal a more serious problem and need medical attention. This guide helps parents and caregivers understand when to seek in-person care for a child's nosebleed. It explains warning signs, what telemedicine can help with, and when a child should be seen by a healthcare provider in person. Remember, this information is for education and triage only and does not replace professional medical advice or diagnosis.

Red flags — go in person / ER

• Nosebleed lasting more than 20 minutes despite firm pressure — seek immediate medical care.
• Signs of significant blood loss such as weakness, dizziness, pale skin, or difficulty breathing — go to emergency care.
• Nosebleed following a head injury or trauma — urgent evaluation needed.

What telemedicine can do

• Providing advice on initial home care for mild nosebleeds.
• Assessing symptoms to determine if in-person care is needed.
• Guidance on preventing future nosebleeds.

What telemedicine cannot do

• Managing heavy or prolonged bleeding that does not stop with pressure.
• Evaluating nosebleeds with signs of serious illness or injury.
• Performing physical examinations or procedures needed for severe cases.

What Causes Nosebleeds in Children?

Nosebleeds in children often happen because the inside of the nose is delicate and can easily get dry or irritated. Common causes include:

Most of these causes are not serious and can be managed at home with simple care.

How to Manage a Nosebleed at Home

If your child has a nosebleed, try these steps:

If bleeding continues beyond 20 minutes despite these steps, seek medical care.

When to Seek In-Person Medical Care

Some nosebleeds may need urgent medical attention. Go to a healthcare facility if your child:

These signs may indicate a more serious condition needing prompt evaluation.

How Telemedicine Can Help

Telemedicine can be useful to:

However, telemedicine cannot replace in-person care when bleeding is heavy, prolonged, or accompanied by serious symptoms.

Preventing Future Nosebleeds

To help reduce nosebleeds in children:

If nosebleeds continue often, a healthcare provider can check for underlying causes.

How to prepare for your tele-visit

• Have a list of your child's symptoms and how long the nosebleed has lasted.
• Note any recent injuries or illnesses your child has had.
• Be ready to describe any other symptoms like dizziness, weakness, or breathing problems.
• Have a quiet place with good lighting for the telemedicine visit.
• Keep a cloth or tissue nearby in case of active bleeding during the visit.

After your tele-visit

• Follow the healthcare provider's advice on home care and monitoring.
• Watch for any new or worsening symptoms and seek care if they occur.
• Use recommended nasal moisturizers or humidifiers to prevent dryness.
• Avoid nose picking or blowing the nose forcefully after a bleed.
• Schedule follow-up care if advised by the provider.

FAQs

What should I do if my child's nosebleed starts again after stopping?

If the nosebleed starts again, repeat the steps of sitting your child up, leaning forward, and pinching the soft part of the nose for 10 to 15 minutes. Avoid letting your child lie down or tilt the head back. If bleeding continues despite these measures, seek medical care.

Can allergies cause nosebleeds in children?

Yes, allergies can cause inflammation and irritation inside the nose, which may lead to nosebleeds. Managing allergies with appropriate treatments and avoiding triggers can help reduce nosebleeds.

Is it normal for children to have frequent nosebleeds?

Occasional nosebleeds are common in children, especially in dry environments or with minor irritation. However, frequent or heavy nosebleeds should be evaluated by a healthcare provider to rule out underlying problems.

When should I take my child to the emergency room for a nosebleed?

Go to the emergency room if your child has a nosebleed that lasts more than 20 minutes despite applying pressure, shows signs of heavy blood loss like weakness or difficulty breathing, or if the nosebleed follows a head injury.

How can I prevent nosebleeds during dry weather?

Using saline nasal sprays or gels can keep the nasal lining moist. Running a humidifier in your child's room can add moisture to the air and reduce dryness that leads to nosebleeds.

Sources

1. Epistaxis (Nosebleed) — MedlinePlus | U.S. National Library of Medicine / National Institutes of Health.
2. Nosebleeds (Epistaxis) — Mayo Clinic.
3. Epistaxis (Nosebleed) in Children — American Academy of Pediatrics (AAP).
4. Nosebleeds (Epistaxis) — Centers for Disease Control and Prevention (CDC).

This telemedicine guidance is for educational and triage purposes only. It is not a substitute for professional medical diagnosis, treatment, or in-person evaluation. If your child has a serious or worsening condition, seek immediate medical care.