Child nosebleed: what to do, and when to see a doctor

A child nosebleed usually stops at home. Sit your child up, lean them forward, and pinch the soft part of the nose for 10 minutes without letting go. NUH says most stop within that time. If the bleeding is still going after 20 minutes of pressure, or it started after a knock to the head or face, take your child to a doctor.

What to do when your child has a nosebleed, step by step

1. Sit your child upright and lean them slightly forward. A young child can sit on your lap, RCH says.
2. Keep the head tipped slightly forward the whole time, because RCH says tilting it back can make your child swallow blood.
3. Pinch the soft part of the nose just above the nostrils, so both sides close. NUH's leaflet says pressing the bony part higher up won't stop a nosebleed.
4. Hold it for 10 minutes without letting go to check. Set a timer: RCH warns it will feel like a long time.
5. Ask your child to breathe through their mouth. NUH says older children can do the pinching themselves.
6. Catch the drips with a tissue or small basin held under the nose. KKH says not to put tissue or gauze into the nose, and NUH says to let your child spit out blood, since swallowed blood can make a child vomit.
7. Let go after 10 minutes and look. If it's still bleeding, NUH says to pinch for another 10 minutes.
8. Still bleeding after 20 minutes of first aid? Take your child to a doctor and keep pinching on the way, as NUH's leaflet advises.
9. Offer an ice-cold drink once it stops. NUH says it cools your child down and clears the taste of blood.
10. Leave the clot alone. RCH says no picking or blowing for 24 hours, and KKH says to blow gently for the next few days.

What to tell grandparents and helpers

If a grandparent or helper looks after your child, show them the steps above. Then go through these four points with them, so everyone handles a nosebleed the same way.

• Keep your child upright with the head forward, since RCH says tipping it back makes them swallow blood and NHS inform advises staying upright rather than lying down.
• Leave tissue out of the nose, because NUH's leaflet says bleeding usually comes back when the stuffing is pulled out.
• Pinch the soft part lower down, as NUH's leaflet says pressing the hard bridge of the nose doesn't stop a nosebleed.
• Use a cold cloth or ice pack only for comfort while you keep pinching. NUH's leaflet says a cold washcloth on the forehead, neck or nose bridge doesn't stop the bleeding, though RCH says a wrapped ice pack can soothe your child.

Why children get nosebleeds

The KKH Children's ENT Centre explains on SingHealth that children bleed from thin blood vessels at the front of the nose, just behind the nostrils. NUH adds that these vessels sit close to the surface and burst easily with rubbing or picking. They usually settle after puberty, once the lining thickens.

KKH's ENT team and NUH name these common triggers:

• Nose-picking, which KKH's team says can also make nosebleeds happen more often
• Colds and allergies. NUH says children with allergic rhinitis, a sensitive nose, may be more prone to bleeds
• Dry or cold air, and air-conditioning, which dries the air
• A knock to the nose or face
• Blowing too hard, which NUH's leaflet lists as a cause
• Something pushed up one nostril, which RCH lists too

KKH's ENT team says bleeding disorders and nasal tumours can cause nosebleeds, but only in rare cases. If the nosebleed came with a cold, our guide to common childhood illnesses in Singapore covers the other symptoms.

How to cut down on repeat nosebleeds

If your child gets them often, these steps come from the hospital leaflets:

• Run a humidifier in the bedroom. KKH's ENT team suggests one, since avoiding an air-conditioned bedroom may not be practical in Singapore's warm climate.
• Smear a little petroleum jelly on the centre wall inside the nose, which NUH's leaflet says often eases dryness. Don't use it under 2: RCH says a young child could breathe it in.
• Before your child blows a stuffy nose, put a few drops of warm water in each nostril, or use a saltwater spray as the label says (NUH's leaflet).
• Keep nails short and steer your child away from picking, which NHS inform and KKH's ENT team both advise.
• Show your child how to blow gently, and only when they need to, as NHS inform suggests.
• Skip aspirin. NUH's leaflet says it can make the body bleed more easily for up to a week.
• If allergies keep the nose itchy, ask your doctor. NUH says some children with allergic rhinitis may benefit from treatment, and the doctor picks which one.

For a baby with a dry, stuffy nose, our baby blocked nose guide shows how to use saline drops. On haze days, our haze guide covers keeping the air at home clean. Keep a cold pack and a small basin with the rest of your first aid kit.

If something is stuck in the nose

A nosebleed from one side, or a smelly discharge, can mean something is stuck up there. KKH's ENT team says its surgeons often find beads, rubber erasers or toys lodged deep in the noses of children with frequent unexplained nosebleeds.

Leave it where it is. NHS advice is that trying to pull it out may push it further in, so show your child how to breathe through their mouth and head to a doctor.

KKH's Children's Emergency treats a foreign body in the nose as an emergency, so take your child there. Go fastest of all for a button battery, which NHS says can cause burns inside the nose.

Common nosebleed or a doctor visit: what you see, what to do

When to see a doctor

Take your child to Children's Emergency at KKH or NUH straight away if:

• the bleeding hasn't stopped after 20 minutes of first aid (NUH)
• it started after an injury, such as a hit to the face or nose (KKH's ENT team, NUH). After a fall or a bump to the head, read our toddler head injury guide too
• the bleeding is heavy, more than a cup, or it makes breathing hard (NUH's leaflet, KKH's ENT team)
• your child feels dizzy, or looks pale, tired or confused (NUH's leaflet, KKH's ENT team)
• your child is bleeding from other places too, or has lots of bruises on the body (KKH's ENT team)
• something is stuck in the nose, above all a button battery (KKH's Children's Emergency, NHS)

Call 995 if your child is very pale, drowsy or stops responding. RCH lists these as reasons to call an ambulance, and KKH's Children's Emergency says to call 995 in an emergency.

See your GP or a polyclinic doctor soon if:

• nosebleeds keep coming back over several weeks, with bruises, gums that bleed or a pale look (NUH)
• they happen 4 to 5 times a month, which KKH's ENT team says needs a specialist review
• your child bruises easily, cuts are slow to stop bleeding, or there's blood in their stools or urine (KKH)
• the bleeding always comes from the same nostril (RCH)
• your child is under 2 (RCH, NHS inform)

Where to go: for anything that isn't an emergency, KKH's Children's Emergency says your family doctor or polyclinic is faster and cheaper. NUH's leaflet also points families to its Children's Urgent Care Clinic at Junction 10 in Bukit Panjang when bleeding hasn't stopped after 20 minutes of pressure. It's a walk-in clinic for children up to 18. At Children's Emergency, NUH says doctors may pack the nose with gauze if a bleed is severe and hard to stop. To find a children's doctor near you, try our paediatrician map.

Frequently asked questions

Child nosebleed, what to do first?

Sit your child up and lean them forward. Pinch the soft part of the nose for 10 minutes without letting go, while they breathe through their mouth. NUH gives this first aid, and says to see a doctor if it's still bleeding after 20 minutes.

How long should a child's nosebleed last?

Most stop within 10 minutes, NUH says. KKH's advice is to see a doctor once the bleeding has gone on for more than 15 minutes, and NUH says to bring your child to its Emergency Department if 20 minutes of first aid hasn't worked. So by 15 minutes, start getting ready to leave and keep pinching.

Should a child tilt their head back during a nosebleed?

No, keep it tipped slightly forward. RCH says tipping the head back can make your child swallow blood, and NUH's leaflet says swallowed blood irritates the stomach and may cause vomiting.

Can air-conditioning cause nosebleeds in children?

It can add to them. KKH's ENT team lists dry or cold air as a common cause, and suggests a humidifier to cut the drying from air-conditioning. NUH's leaflet suggests running one in the bedroom at night.

Are frequent nosebleeds in children serious?

Usually not. KKH's ENT team says one nosebleed every few months is unlikely to be a concern, but 4 to 5 a month should be checked by a specialist. If repeat nosebleeds come with bruises, gums that bleed or a pale look, NUH says to see a doctor at the earliest opportunity.

Is a nosebleed in a baby normal?

It's not common. RCH says nosebleeds are unusual in children under 2, and both RCH and NHS inform say a baby with a nosebleed should see a doctor. Keep petroleum jelly out of a baby's nose, since RCH says they could breathe it in.