Dr Phil Kieran: Should we worry about my teen's nosebleeds? 

Teen boy wipes his nose with a napkin isolated

My 14-year-old son has started to get sudden nose bleeds, but which stop quickly. There is no apparent cause for them. He is anxious that he might get a bleed while he is out with friends. So far, he has had three bleeds in as many months. Should we be worried?

Nosebleeds in children and teenagers are common, but, thankfully, they are rarely something to worry about.

They usually result from a small cut inside the nose near the opening, where there is a collection of delicate blood vessels close to the surface.

Anything that irritates the inside of the nose can cause bleeding. The most common of these is direct trauma from itching or picking (which is much more common than most people think, with a study showing that 91% of us do so).

This irritation can also be caused by the skin inside the nose drying out in air-conditioned environments, or because of infections like common colds and covid.

To stop a nosebleed, we apply pressure to the nose. However, mostly I see people applying pressure to the wrong place, squeezing the bony bridge of the nose, which is uncomfortable and doesn’t achieve anything. You should pinch the nose closed from both sides and lean slightly forward. This action will stop blood pooling in the back of the throat, which can cause choking, coughing, or nausea, if you swallow a lot of it.

If frequent nosebleeds occur and, at the same time, the person starts to develop unexplained bruising, rashes, or extreme fatigue, a baseline blood test is recommended to make sure that their platelet count is normal and that there isn’t any other haematological abnormality.

In your son’s case, one nosebleed a month isn’t excessive, so it is unlikely to be a sign of anything worrying. If he has had a nosebleed that has stopped, he should refrain from blowing his nose or rubbing it firmly for 24-48 hours. He should also avoid heavy lifting or straining (such as weight training) for this period, as it can dislodge a clot that has formed.

If the air in his bedroom is very dry, using a humidifier at night could help. If not, look for an OTC nasal spray for a dry nose.

He should keep his fingernails short, as odds are he is in the 91% of people who at least occasionally pick their nose.

If none of these steps help and if the nosebleeds are becoming more frequent, it might be worth talking to your GP about seeing an ENT surgeon to consider cauterising the bleeding vessels.

In this mildly painful procedure, the blood vessels inside the front part of the nose are sealed using either heat or a chemical called silver nitrate.

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