Pediatric Game of Thrones: Spring is Coming! Pollen is Here!

Yes, folks! It is allergy season. Pollen is definitely here. I am sure you have all noticed that flaky yellow dust collecting on your car or patio furniture. With the onset of spring allergies, Pediatricians see a sudden influx of clinic visits for a very common complaint…. nosebleeds. The medical term for this is epistaxis. What can seem like a very urgent or life-threatening event to some parents, is actually a benign and common occurrence in the Pediatric world.
Not many things are more alarming than a bloodied and panicked child. If we delve into the mechanism behind the onset of a nosebleed, we can come to realize how quickly and easily they occur. The nostrils are a highly vascularized area, meaning that there are a lot of blood vessels. With the spring allergy season, there may be fluctuations in the temperature from day to day or even hour to hour. This may cause sudden changes from vasoconstriction to vasodilation or vise versa. In an area with such a thin barrier such as nasal mucosa, one can see how these rapid changes in blood vessel size could lead to a tear and subsequent bleeding.
Also within the allergy season, many children develop runny noses (referred to as rhinitis by your child’s physician). Both rhinitis itself and the “nose rubbing” which occurs, as a result, can lead to irritation and breaking of these superficial vessels. Within and outside of the allergy season, another possible and likely trigger is simply nose picking. Many children go through a nose picking phase, either during the toddler age group after discovering the nose and nostrils, or in an older child who has persistent rhinitis or thicker nasal discharge.
While a Hemoglobin level could be checked very easily in the clinic setting via a quick prick of the finger, such testing is generally not indicated. Despite the apparent visual of “blood everywhere”, even with a history of daily occurrences, one must keep in mind the small size of the blood vessels which cause epistaxis.
I sometimes have parents ask me for a “work up” or a referral to Hematology for epistaxis. Again, these steps are also unwarranted. A child with a bleeding disorder or low platelet count would have other symptoms present, including but not limited to: bleeding in joints, gum bleeding, petechiae (microhemorrhages under the skin), etc., and would not present simply with isolated nose bleeding.
Lastly, the avoidance of excess panic and discomfort for the child and parent relies on proper reaction to the onset of nose bleeding. The child should immediately pinch the nose with soft tissue paper (not a paper towel or other thick harsh wipes, which may cause further irritation) for ten minutes while breathing through the mouth. The head should be held in a neutral position (looking forward) and should not be tipped back as to avoid any swallowing/choking on blood running down the back of the throat. The majority of cases will stop after pressure is held for ten minutes. The very few cases remaining will resolve after 2nd hold for further 10 minutes. During 10 minute hold, at no time should pressure be released to check for bleeding, as consistent pressure is key to the resolution of symptoms.

Thanks for reading!