You are talking to customer Joanna Fraser about her four-year-old son Oliver.
"Do I need to worry about the nosebleeds he keeps getting?" she asks. "To start off with, I didn't think much of it, but they seem to be happening more and more often, and can last quite a while. I wonder whether I've just got used to him coming home from school with blood on his jumper, and having to wash his pillow, when maybe I should be getting him seen by a doctor. What do you think?"
What are the causes of nosebleeds?
Nosebleeds, also known as epistaxis, are quite common in children and are usually a result of one of the tiny blood vessels inside the nose being broken due to an injury such as a bump, nose picking, blowing the nose or repeated use of nasally administered medication.
The mucous membranes inside the nose becoming dried out can also have the same effect, and nosebleeds may occur if someone is suffering from a blocked nose due to a cold, sinusitis or hayfever, or has been in a drier environment than usual, for example, an air conditioned office, hot climate, oxygen therapy or high altitude.
In some cases – and more commonly in adults than children – the bleeding may stem from the artery that supplies the nasal cavity. Causes of this include a blow to the head, hypertension, atherosclerosis, chemical exposure, anticoagulant medication and tumours. The bleeding is usually profuse and both sides of the nose are affected.
Should Joanna seek medical advice about Oliver's nosebleeds?
Most nosebleeds can be stopped by firmly pinching the soft part of the nose in between the nostrils and the cartilage near the eyes for 10 to 15 minutes, or placing an ice pack on the bridge of the nose. Leaning forward and breathing through the mouth ensures that blood drains through the nose rather than going down the throat, needing to be spat out or swallowed.
However, regular nosebleeds (more than one a week) warrant investigation, and this seems to be the case for Oliver. A GP referral to an ENT specialist will allow a thorough examination to take place. If a blood vessel is identified as causing the nosebleeds, it can be cauterised to seal it, though the procedure can be painful. If a deviated septum is to blame, this can be surgically straightened. If an artery is the source of the problem, it can be ligated.
References
● NHS Inform nhsinform.co.uk/health-library/articles/n/nosebleed/treatment ● Great Ormond Street Hospital gosh.nhs.uk/medical-conditions/search-for-medical-conditions/nose-bleed/nose-bleed-information/ ● St John Ambulance sja.org.uk/sja/first-aid-advice/wounds-and-bleeding/nosebleeds.aspx ● Clinical Knowledge Summaries cks.nice.org.uk/epistaxis
If you identify a gap in your knowledge, you might want to consider making a CPD entry.