This is the 39th article written in a series for Princeton Online Click here for an archive of other articles.
Nosebleeds, though common and often alarming to witness, are, thankfully, not usually serious. Many of us have suffered a nosebleed as a consequence of an injury to the nose. We do not view these nosebleeds as particularly surprising. However, spontaneous nosebleeds can startle the observer because of the apparent volume of the bleeding and the absence of evident cause. Moreover, they are sloppy - getting all over clothing and bed linens. Awareness of the mechanism, causes and treatment of epistaxis in children can lessen anxiety about the process and, hopefully, prevent some of the sloppiness!
Just inside the nostril is a collection of capillaries (called Hasselbach's plexus) on the middle wall of the nose. This is the most common site of spontaneous nosebleeds in children. Simple inspection of this area after a nosebleed can often identify the offending vessels - a pleasant job most often left to the pediatrician. These blood vessels, which are simply tubes constructed of cells that are adherent to one another, become dilated when inflamed. This dilatation creates gaps between the cells, which can no longer withstand increasing pressure of the blood that fills the vessels. This pressure is less when a person is quietly standing so that gravity pulls blood away from the face. However, as a result of increases in local pressure when reclining or bending over, when sneezing or coughing, or when experiencing a minor injury not normally forceful enough to cause a nosebleed, the dam bursts and the blood gushes out. Actually, although the volume of blood often seems to be greater than that of the Mediterranean Sea, it is usually only a couple of teaspoon's worth. Signs that the bleeding is excessive include light-headedness, pallor, rapid pulse, rapid respirations or low blood pressure. Should any of these rare occurrences supervene, you should either call the Rescue Squad or transport your child to a medical facility as soon as you can.
Among the common reasons for the lining of the nose to be inflamed are colds, allergies (even in the absence of other allergy symptoms) and overuse of decongestant nose drops. Other topical or oral medications may also trigger nosebleeds. Less common conditions that can cause recurrences of nosebleeds or bleeding from other sites usually involve abnormal platelet function or number, or inability to clot. An examination by your pediatrician, sometimes supplemented by simple laboratory tests, can usually determine the cause.
We have all learned from our elementary first aid training that the preferred method to stop bleeding is by direct pressure on the bleeding site. That is fine for a cut on the forearm, but most folks would be reluctant to use their fingers for direct pressure on Hasselbach's plexus! As luck would have it, by squeezing the nose on the soft part just under the juncture of the nasal bones and the nasal cartilage from the outside of the nose, pressure is conveniently applied directly to the offending vessels. We recommend having the child tip his or her head forward slightly during this process to avoid swallowing any blood that is dripping down the back of the nose into the throat. Our main goal with this position is to prevent the child from vomiting the blood (blood in the stomach is notorious for this distasteful complication) all over the child's caretaker (you). The nose must be pinched in this fashion for at least eight to ten minutes continuously (no peeking!). Shorter periods often necessitate recommencing the entire process. A girl might find that 40 to 60 minutes of pressure is necessary if a nosebleed occurs during her menstrual period. This is due to natural anticoagulants that are found normally in the blood at this time. Pressure or application of cold packs under the upper lip, on the bridge of the nose or on the nape of the neck are not helpful, despite the fact that these alternate methods seem to be steeped in tradition.
Most nosebleeds are re-bleeds. Once the epistaxis is stopped, the clot that forms on the breach in the vessel is loosely attached and can easily be dislodged by a wanton sneeze or a careless nose rub. After a nosebleed stops, gently spraying a saline solution (a number of different brands are available over the counter) a few time per day for a day or two to rinse out any dried blood and carefully applying petroleum jelly inside the nostrils to keep the skin lubricated may be of benefit in preventing recurrences. If a child has repeated of epistaxis, or displays a seasonal pattern to the bleeding, your child's physician can suggest a regimen, usually comprised of allergen avoidance - particularly dust (see our article on Allergies), anti-allergy nasal sprays, and sometimes brief use of topical decongestant nasal preparations. Maintaining your home environment at a cool 65-70 degrees F with the relative humidity between 40 and 60% will often make nosebleeds less frequent. If your child prefers, as many children do, to sleep with stuffed animals, putting the toys in your drier on high heat for 30 minutes twice weekly may kill the dust mites so you can let your child continue to derive comfort and security from the stuffed animals. Likewise, during your child's allergy season, you may wish to get in the habit of having him or her bathe at night. This removes any available pollen from striking distance of those nostrils and the all-important Hasselbach's Plexus.
With the measures described in this article, you should be able to minimize the number of nosebleeds your child suffers and make his/her life that much more pleasant (your's, too!). As always, call your child's doctor with any concerns or questions you might have regarding his/her individual health.
The Fall-Season after the twins were born, I had developed serious sinus troubles. I didn't know they were sinus troubles. I was just getting bad headaches, like most people, post 9-11 stress.
I went to a series of doctors, because I kept having sinus infections. [Later on, I had read somewhere that stress can lead to sinus infections, too!] It turned out, I was in need of surgery. My sinuses were so badly infected, they were about to rupture.
From that point on, I learned: saline spray and effective sniffing, and decongestants like Sudafed are my friends... anti-histamines, like Benadryl is NOT. Moisture and Motrin is a YAY, anything drying is a NAY!
True, since my brain injury, I do have selective memory, however, from what I do remember, as a child, I always had trouble with allergies, especially in the Fall-Season, and in Church, with that horrible incense those priests would shake around!!!! <cough, cough> Could there be any worse torture for a child with red swollen eyes?
So, for those with sensitive skin and noses, keep aware of drying agents on all mucus-membranes, and read-up on allergy articles, especially if you were adopted!
As a child I had many nose bleeds and was really allergic to pollen, dust, in short everything that is small particular. The nose bleeds at first scared me a lot cause they wouldn't easily stop. Around puberty the nose bleeds stopped and the allergies have been a lot less since I started smoking.
<laughing> you've got all that tar-build-up clogging those nares and lungs and such... no room to bleed, so you can breathe better!
Go figure!
Just think all that cancer-research down the drain!
Hey... good thing I'm no doctor! <WHEW!> I could get sued for that stuff!
You know... that's what got this whole thing started... the whole need for weed. Who was ruling in the UK when The London and Virginia Company came scouting for tobacco in 1610? [Admin, we need maps & info pages for this historical migrant stuff!]
I used to glory in them, collect the blood in whatever I could find on the spur of the moment and carry it around to show to people, until it started to smell bad
Robin
Think of us as the new-crops of industrial revolution testing the laws of biology and immigration. Want to see how far we've come in terms of that field of thinking? Read this seemingly unrelated article on a different-breed of farm-families trying to move their way into America: http://www.msnbc.msn.com/id/21491778
Growing-up I always had "sensitivities". Allergies to the seasons were new and different to my adoptive family, making me more "special" than the rest, as a result.
Oddly enough, my natural parents were farmers in Alberta, Canada... yet I was birthed in a fishing town, clear across the country. Why? I don't know. I live now in a rural area where farming takes place. I don't know how much longer we can stay here, as it seems to be hurting my children's allergies too much. The plumes of chemicals and dry air in the fall keep my children choking and wheezing for weeks, yet we can't afford to move because only hub-man works (I stay home with the kids and do the website for free).
People don't realize how environment affects biology, and biology reacts to the changes caused by placement.
I wonder when that connection will be made.... and taken more seriously, because stories like Robin's cup runneth-over sure do tell a tale of it's own personal gore and misery, in a most peculiar way, doesn't it?
i'm very simple in my thinking, so bear with me as i share my reasons as to why i believe people should not replace crops and vegetation with people and children in another man's nation:
God says to be fruitful and multiply, yet no where does he say to marry as an order to defy
God says to honor your mother and father, and love your brother as yourself
where in the bible, then, is slave and laborer to the land beneath the receiving of equal (royal) help?
international adoption fits in the works of good deeds and services towards man-kind how and why?
break a mother and child, tear a family apart, sell the pieces to strangers, and call it what you want.
i call it un-whole.
i wonder what would the almighty Holy-One would call it, too.
Comments
Spontaneous Nosebleeds & Allergies
Spontaneous Epistaxis (Nosebleeds) in Children
By Mark B. Levin, M.D., Timothy J. Patrick-Miller, M.D. and Louis J. Tesoro, M.D.
The Pediatric Group, P.A., Princeton
This is the 39th article written in a series for Princeton Online Click here for an archive of other articles.
Nosebleeds, though common and often alarming to witness, are, thankfully, not usually serious. Many of us have suffered a nosebleed as a consequence of an injury to the nose. We do not view these nosebleeds as particularly surprising. However, spontaneous nosebleeds can startle the observer because of the apparent volume of the bleeding and the absence of evident cause. Moreover, they are sloppy - getting all over clothing and bed linens. Awareness of the mechanism, causes and treatment of epistaxis in children can lessen anxiety about the process and, hopefully, prevent some of the sloppiness!
Just inside the nostril is a collection of capillaries (called Hasselbach's plexus) on the middle wall of the nose. This is the most common site of spontaneous nosebleeds in children. Simple inspection of this area after a nosebleed can often identify the offending vessels - a pleasant job most often left to the pediatrician. These blood vessels, which are simply tubes constructed of cells that are adherent to one another, become dilated when inflamed. This dilatation creates gaps between the cells, which can no longer withstand increasing pressure of the blood that fills the vessels. This pressure is less when a person is quietly standing so that gravity pulls blood away from the face. However, as a result of increases in local pressure when reclining or bending over, when sneezing or coughing, or when experiencing a minor injury not normally forceful enough to cause a nosebleed, the dam bursts and the blood gushes out. Actually, although the volume of blood often seems to be greater than that of the Mediterranean Sea, it is usually only a couple of teaspoon's worth. Signs that the bleeding is excessive include light-headedness, pallor, rapid pulse, rapid respirations or low blood pressure. Should any of these rare occurrences supervene, you should either call the Rescue Squad or transport your child to a medical facility as soon as you can.
Among the common reasons for the lining of the nose to be inflamed are colds, allergies (even in the absence of other allergy symptoms) and overuse of decongestant nose drops. Other topical or oral medications may also trigger nosebleeds. Less common conditions that can cause recurrences of nosebleeds or bleeding from other sites usually involve abnormal platelet function or number, or inability to clot. An examination by your pediatrician, sometimes supplemented by simple laboratory tests, can usually determine the cause.
We have all learned from our elementary first aid training that the preferred method to stop bleeding is by direct pressure on the bleeding site. That is fine for a cut on the forearm, but most folks would be reluctant to use their fingers for direct pressure on Hasselbach's plexus! As luck would have it, by squeezing the nose on the soft part just under the juncture of the nasal bones and the nasal cartilage from the outside of the nose, pressure is conveniently applied directly to the offending vessels. We recommend having the child tip his or her head forward slightly during this process to avoid swallowing any blood that is dripping down the back of the nose into the throat. Our main goal with this position is to prevent the child from vomiting the blood (blood in the stomach is notorious for this distasteful complication) all over the child's caretaker (you). The nose must be pinched in this fashion for at least eight to ten minutes continuously (no peeking!). Shorter periods often necessitate recommencing the entire process. A girl might find that 40 to 60 minutes of pressure is necessary if a nosebleed occurs during her menstrual period. This is due to natural anticoagulants that are found normally in the blood at this time. Pressure or application of cold packs under the upper lip, on the bridge of the nose or on the nape of the neck are not helpful, despite the fact that these alternate methods seem to be steeped in tradition.
Most nosebleeds are re-bleeds. Once the epistaxis is stopped, the clot that forms on the breach in the vessel is loosely attached and can easily be dislodged by a wanton sneeze or a careless nose rub. After a nosebleed stops, gently spraying a saline solution (a number of different brands are available over the counter) a few time per day for a day or two to rinse out any dried blood and carefully applying petroleum jelly inside the nostrils to keep the skin lubricated may be of benefit in preventing recurrences. If a child has repeated of epistaxis, or displays a seasonal pattern to the bleeding, your child's physician can suggest a regimen, usually comprised of allergen avoidance - particularly dust (see our article on Allergies), anti-allergy nasal sprays, and sometimes brief use of topical decongestant nasal preparations. Maintaining your home environment at a cool 65-70 degrees F with the relative humidity between 40 and 60% will often make nosebleeds less frequent. If your child prefers, as many children do, to sleep with stuffed animals, putting the toys in your drier on high heat for 30 minutes twice weekly may kill the dust mites so you can let your child continue to derive comfort and security from the stuffed animals. Likewise, during your child's allergy season, you may wish to get in the habit of having him or her bathe at night. This removes any available pollen from striking distance of those nostrils and the all-important Hasselbach's Plexus.
With the measures described in this article, you should be able to minimize the number of nosebleeds your child suffers and make his/her life that much more pleasant (your's, too!). As always, call your child's doctor with any concerns or questions you might have regarding his/her individual health.
Serious Sinus Troubles
The Fall-Season after the twins were born, I had developed serious sinus troubles. I didn't know they were sinus troubles. I was just getting bad headaches, like most people, post 9-11 stress.
I went to a series of doctors, because I kept having sinus infections. [Later on, I had read somewhere that stress can lead to sinus infections, too!] It turned out, I was in need of surgery. My sinuses were so badly infected, they were about to rupture.
From that point on, I learned: saline spray and effective sniffing, and decongestants like Sudafed are my friends... anti-histamines, like Benadryl is NOT. Moisture and Motrin is a YAY, anything drying is a NAY!
True, since my brain injury, I do have selective memory, however, from what I do remember, as a child, I always had trouble with allergies, especially in the Fall-Season, and in Church, with that horrible incense those priests would shake around!!!! <cough, cough> Could there be any worse torture for a child with red swollen eyes?
So, for those with sensitive skin and noses, keep aware of drying agents on all mucus-membranes, and read-up on allergy articles, especially if you were adopted!
Smoking
As a child I had many nose bleeds and was really allergic to pollen, dust, in short everything that is small particular. The nose bleeds at first scared me a lot cause they wouldn't easily stop. Around puberty the nose bleeds stopped and the allergies have been a lot less since I started smoking.
Makes sense...
<laughing> you've got all that tar-build-up clogging those nares and lungs and such... no room to bleed, so you can breathe better!
Go figure!
Just think all that cancer-research down the drain!
Hey... good thing I'm no doctor! <WHEW!> I could get sued for that stuff!
You know... that's what got this whole thing started... the whole need for weed. Who was ruling in the UK when The London and Virginia Company came scouting for tobacco in 1610? [Admin, we need maps & info pages for this historical migrant stuff!]
Your suggestion
I completely agree Kerry. We do need maps and a timeline for that. Still need to figure out <mumbling something technical>.
Coin-toss
Heads: ask for help from a few friends
Tails: give it to Niels to do!
Nose bleeds, oh yes...
I used to glory in them, collect the blood in whatever I could find on the spur of the moment and carry it around to show to people, until it started to smell bad
Robin
*
Agriculture, Allergies, and Adoptees
Think of us as the new-crops of industrial revolution testing the laws of biology and immigration. Want to see how far we've come in terms of that field of thinking? Read this seemingly unrelated article on a different-breed of farm-families trying to move their way into America: http://www.msnbc.msn.com/id/21491778
Growing-up I always had "sensitivities". Allergies to the seasons were new and different to my adoptive family, making me more "special" than the rest, as a result.
Oddly enough, my natural parents were farmers in Alberta, Canada... yet I was birthed in a fishing town, clear across the country. Why? I don't know. I live now in a rural area where farming takes place. I don't know how much longer we can stay here, as it seems to be hurting my children's allergies too much. The plumes of chemicals and dry air in the fall keep my children choking and wheezing for weeks, yet we can't afford to move because only hub-man works (I stay home with the kids and do the website for free).
People don't realize how environment affects biology, and biology reacts to the changes caused by placement.
I wonder when that connection will be made.... and taken more seriously, because stories like Robin's cup runneth-over sure do tell a tale of it's own personal gore and misery, in a most peculiar way, doesn't it?
old-school and rules
i'm very simple in my thinking, so bear with me as i share my reasons as to why i believe people should not replace crops and vegetation with people and children in another man's nation:
break a mother and child, tear a family apart, sell the pieces to strangers, and call it what you want.
i call it un-whole.
i wonder what would the almighty Holy-One would call it, too.