How to manage nosebleeds in children, with tips to prevent further nosebleeds

A “patient page” in the journal JAMA Otolaryngology–Head & Neck Surgery focuses on how parents or caregivers can manage childhood nosebleeds (epistaxis) at home. The article also describes techniques to prevent future nosebleeds and when to seek medical evaluation. Nosebleeds affect about 30% of children younger than five years and 50% of children five years or older, but are generally not serious. Although the bleeding originates in the nose, and may come out of one or both sides of the nose, it may also be seen in the mouth. Parents, caregivers and children should be educated about the following:The septum The inside of the nose is separated in the middle by a piece of cartilage and bone called the septum, which is a thin lining filled with tiny blood vessels. These blood vessels moisturize, warm and filter the air we breathe. The septum is fragile and may easily tear and bleed when the nose is picked, rubbed or blown.Causes Anything that dries out or injures the inside of the nose can cause a nosebleed. Examples include inflammation from an upper respiratory infection or allergies, use of decongestant nasal sprays, heated indoor spaces, high altitudes, dry climates, injuring the face or nose, or inserting anything into the nose.Anterior and posterior nosebleeds Bleeding from the front of the nose is called an anterior nosebleed—these are the most common type. Bleeding from the back of the nose is called a posterior nosebleed. On rare occasions, posterior nosebleeds occur from larger blood vessels in the back of the nose. In these situations, the bleeding mainly goes down the throat rather than out the nose, and it may be difficult to stop. Steps for stopping a nosebleed at homeStay calm. Instruct the child to breathe through their mouth.Sit the child up (or sit them on your lap facing away from you), leaning slightly forward with their head tilted forward (see illustration in the online patient guide).Pinch the soft part of nose above the nostrils together continuously for at least 10 minutes.After the bleeding stops, large clumps of blood (blood clots) may come out of the nose or mouth. This is normal and is the body’s way of stopping the bleeding.Seek emergency medical attention if the bleeding does not stop after 30 minutes, the volume of blood is more than one cup (about 240 mL), the child is having difficulty breathing or is vomiting from swallowing blood.If a nosebleed does not stop with pressure and medical care is needed, explain that a doctor may use a nasal pack to put pressure on the bleeding. A medication may be put on the area of bleeding to help the bleeding stop (called cauterization). The inside of the nose is numbed and the bleeding blood vessel is sealed.Tips to help prevent further nosebleedsKeep the skin of the nose hydrated to make it less prone to injury. This can be done using a saline nasal spray (available over-the-counter) at least once or twice daily to moisturize the nasal passages.Moisturize the air with a humidifier in the bedroom.Gently apply a saline gel (available over-the-counter) inside the front of the nose on both sides with a cotton swab.Avoid trauma to the nose. Do not put objects (including fingers) in the nose—cut children’s fingernails short. Sneeze with the mouth open. Do not forcefully blow the nose.Medical conditions that prevent blood from clotting may cause or worsen nosebleeds in children. See a doctor if a child has frequent nosebleeds that are difficult to stop at home or interfere with daily life.ReferenceEspinel AG. Nosebleeds in children. JAMA Otolaryngol Head Neck Surg 2025; published online June 12, 2025. (accessed June 17, 2025).

How to manage nosebleeds in children, with tips to prevent further nosebleeds

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