Dr Phil Kieran: My son has nosebleeds three times a week

For most, nosebleeds are infrequent and don’t last very long. Picture: iStock 

My 13-year-old son has started to get nosebleeds two to three times a week. They don’t last long — usually just a few minutes — and stop quickly when we pinch his nose. The bleeds mostly happen in the evening or after he plays hurling. Though he knows he shouldn’t, he picks his nose when it’s dry, as he finds the crusted blood annoying. We have no family history of blood disorders, and he otherwise seems well. What would you suggest?

Nosebleeds are very common. At least 60% of people have had at least one nosebleed in their lives, and about 9% of children have recurrent nosebleeds. For most, they are infrequent and don’t last very long.

Your son’s case would be classified as more frequent than usual (most guidelines suggest two to three episodes per month at most). It’s still likely that there is no underlying medical abnormality, but it is worth seeing your GP for a check-up.

Given that the bleeds often happen after hurling, make sure his helmet fits well, protect the face against ball strikes and, most importantly, check that he is wearing it.

The first thing I would be looking for in your son’s case would be an area of persistent irritation or infection. Nosebleeds multiple times per week could indicate an irritation that is not healing. If this area appears infected, I would prescribe an antibacterial cream.

You mention that your son often picks the crusty-feeling areas after a bleed. I sympathise with him— it can be difficult to stop yourself when it is uncomfortable, though this isn’t advisable.

Using a saline rinse or gel regularly can help remove and reduce these dry areas without causing damage to the underlying skin. This treatment is available over the counter in pharmacies and is worth trying.

If the measures above don’t stop the bleeding, the next step would be to refer your son to an ENT specialist.

In some people, the vascular area inside the nose is prone to bleeding for various reasons.

If this appears likely to cause ongoing bleeds, an ENT surgeon will often cauterise the area.

I also had very frequent nosebleeds as a child, and my sisters used to terrorise me by saying cautery is done by sticking a red-hot metal spike into your nose. Thankfully, the truth is less dramatic. Often the procedure is carried out by using a small stick coated with silver nitrate. This causes a slight chemical burn, which is usually only mildly painful.

Even though, in your son’s case, the nosebleeds are more frequent than average, the basic advice on how to treat or prevent them is worth reviewing.

When a nosebleed happens, pinch the nose closed and hold it this way for about 10-15 minutes. When the bleeding has stopped, try not to rub, bump, or blow the nose for the next 24 hours. This allows the scab to heal and fall off by itself.

Preventing nose picking completely is probably impossible, so I suggest keeping the nails short and consider filing rather than cutting them, as this leaves fewer sharp edges.

Though I recommend seeing the doctor for a check-up at this point, you can take comfort from the fact that research shows that a lot of children will ‘grow out’ of nosebleeds by the age of 14, so there is a high likelihood that this problem will sort itself out.

• If you have a question for Dr Phil Kieran, please send it to [e-mail] or use the form below