First Aid Management for Pediatric Nosebleeds (Epistaxis)

Initial Management

The American Heart Association recommends positioning the child in a sitting position with head tilted slightly forward to prevent blood from entering the airway or stomach 1, 2
The American Academy of Otolaryngology-Head and Neck Surgery suggests having the child breathe through the mouth and spit out any blood rather than swallowing it 2
The American Heart Association recommends applying firm, continuous pressure by pinching the soft lower third of the nose for at least 5 minutes, preferably 10-15 minutes without checking if bleeding has stopped 1, 2
Compression alone is sufficient to stop bleeding in the majority of cases, according to the American Heart Association 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery recommends clearing any blood clots from the nose and applying a topical vasoconstrictor such as oxymetazoline or phenylephrine (2 sprays in the bleeding nostril) 3, 4
This approach resolves 65-75% of nosebleeds that present for medical attention, according to the American Academy of Otolaryngology-Head and Neck Surgery 4

The American Academy of Otolaryngology-Head and Neck Surgery suggests applying moisturizing or lubricating agents such as petroleum jelly to prevent recurrence, and recommend regular use of saline nasal sprays to keep the nasal mucosa moist 5, 6
Consider using a humidifier, especially in dry environments, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 6

The American Heart Association recommends seeking medical attention if bleeding does not stop after 15 minutes of continuous pressure, or if the child experiences dizziness, weakness, or lightheadedness 1, 3, 5
If the child has a history of bleeding disorders or is taking anticoagulant medications, seek medical attention, according to the American Heart Association 1

The American Heart Association warns against insufficient compression time, tilting the head backward, using ice or cold compresses directly on the nose, and inserting tissues or cotton into the nostrils 1, 2, 5

Children under 3 years of age may require different management approaches as guidelines are primarily focused on children 3 years and older, according to the American Academy of Otolaryngology-Head and Neck Surgery 7
Children taking anticoagulant medications should be evaluated by a healthcare professional even if bleeding stops, as recommended by the American Heart Association 1