Nosebleeds occur commonly during childhood. They are most common during the early school aged years and usually requires no diagnostic evaluation. 

Most bleeding is from the anterior septum (Kiesselbach's plexus) where there is a large number of blood vessels. This area has little subcutaneous tissue to allow blood vessel retraction that aids in hemostasis. 

Common Etiologies

1. Digital manipulation 
2. Dryness of the nasal tissues most commonly during the winter months. Nosepicking increases the risk of bleeding. Rubbing susceptible area on the pillow may lead to bleeding while child is asleep. 
3. Ulcerations of the mucosa
4. Inflammation of the mucosa secondary to allergies or infections
5. Bleeding disorders
1. VonWillebrand's Disease- decrease of VW factor which helps transport factor VIII and affects platelet adhesiveness. May also be associated with low levels of factor VIII
2. Factor VIII and IX deficiencies
3. Leukemia
4. platelets 
6. Osler Weber Rendu Syndrome- mucosal telangectasias
7. Granulomas secondary to chronic infections
8. Polyps
9. Benign and malignant tumors including angiofibromas and rhabdomyosarcomas
10. Trauma 
11. Unilateral purulent bloody drainage with foul smell usually associated with foreign body in the nose.

1. History- family history of bleeding , previous nosebleeds, medications including nasal sprays, trauma, nosepicking, surgery
2. Physical examination- location of the bleeding, petechiae, bruising, evidence of trauma, lymphadenopathy, organomegaly, skin changes
3. The correct way to stop the bleeding is to pinch the nose, putting pressure on Kieselbach's plexus, and tilt the head forward. This will prevent posterior trickling of blood which can cause nausea and vomiting. This position may also facilitate clot formation. 
4. If the bleeding is from a posterior source, may need to use packing with Vaseline gauze.
5. If unable to stop the bleeding, or is recurrent, ENT may need to cauterize the area with silver nitrate. 
6. Vaporizer in the room at night to prevent drying of the nasal mucosa.  Also cold on bridge of the nose or nape of the neck can stimulate autonomic responses leading to narrowing of blood vessels.
7. Use of Vaseline or antibacterial ointment to prevent scab formation in the nose that causes itching and increases manipulation.
8. Cotton swab soaked with Witch Hazel inside the nostril could lead to vasoconstriction of tiny blood vessels. 

1. Mulbury, Peter E. Recurrent Epistaxix. Pediatrics in Review. January 1991
2. Index of Suspicion. Case 3. Pediatrics in Review May 2004