Nosebleeds are also known as epistaxis. Anterior nosebleeds usually originate from Kiesselbach’s plexus, which is located in Little’s area. This is an area of the nasal mucosa at the front of the nasal cavity that contains many blood vessels. When the mucosa is disrupted in this area and the blood vessels are exposed, for example due to trauma from a child picking their nose, they are prone to bleeding.
TOM TIP: Little’s area (the area most affected by Little fingers) is a popular topic in exams. Remember the name of this area, as examiners often ask, “What is the most likely location of the bleeding?”
Presentation
Nosebleeds are common in young children. They can be triggered by:
- Nose picking
- Colds
- Sinusitis
- Vigorous nose-blowing
- Trauma
- Changes in the weather
- Coagulation disorders (e.g., thrombocytopenia or von Willebrand disease)
When a child swallows blood during a nosebleed, they may present with vomiting blood.
Bleeding is usually unilateral. Bleeding from both nostrils may indicate bleeding posteriorly in the nose. Posterior bleeding is associated with a higher risk of blood aspiration.
Management
Nosebleeds usually resolve without medical assistance. Recurrent and significant nosebleeds may require further investigation to identify an underlying cause, such as thrombocytopenia or a clotting disorder.
You may have to advise patients on how to manage a nosebleed in an exam:
- Sit up and tilt the head forwards (tilting the head backwards is not advised as blood will flow towards the airway)
- Squeeze the soft part of the nostrils together for 10 – 15 minutes
- Spit out any blood in the mouth, rather than swallowing
When bleeding does not stop after 10 – 15 minutes, the nosebleed is severe, bleeding is from both nostrils, or the patient is haemodynamically unstable, hospital admission may be required. Treatment options are:
- Nasal cautery using silver nitrate sticks
- Nasal packing using nasal tampons or inflatable packs
After treating an acute nosebleed, consider prescribing Naseptin nasal cream (chlorhexidine and neomycin) four times daily for 10 days to reduce any crusting, inflammation and infection. Naseptin previously contained peanut oil and was contraindicated in peanut or soya allergy (although the new formulation does not and is safe in allergies).
Last updated June 2026
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