Nasal bleeding is a common symptom in pediatric ENT clinics, and ongoing nosebleeds are also a common situation for emergency management in ENT. Although most children do not bleed much or for a long period of time, children can feel fearful when nosebleeds occur and recurrent nosebleeds can be a problem for parents, so it is especially important to know how to handle nosebleeds urgently when they occur and to suggest preventive measures based on the cause. Nasal bleeding can be caused by both local and systemic diseases. Traumatic injuries such as frequent nose blowing, nose picking, nasal injuries from falls, medical injuries, etc. Nasal foreign bodies Children often stuff toys, flower seeds, paper balls, fruit kernels, etc. into the nasal cavity for a period of time out of curiosity, causing secondary infection and resulting in mucosal erosion. Inflammation of the nose and sinuses Inflammation can lead to nasal blockage, increased secretion and nasal itching, resulting in children often picking and rubbing their noses with their hands, leading to nasal bleeding. Tumors of the nose Such as benign tumors of vascular origin in the nasal cavity or nasopharynx, which bleed relatively more and often occur in young adults; malignant tumors of the nose, such as lymphoma, can also lead to nasal bleeding. Acute febrile diseases High fever from various diseases leads to dryness of the nasal mucosa and ruptured bleeding from dilated blood vessels. Hematological causes Such diseases can lead to abnormal coagulation mechanism or deficiency of coagulation components in children, which can lead to nasal bleeding and the bleeding cannot be easily stopped. Vitamin deficiency Most often, vitamin deficiency causes nasal bleeding due to inadequate nutritional intake caused by partial eating. Others Such as rheumatism, hereditary capillary dilation, or chemical substance poisoning such as phosphorus, mercury, arsenic, etc. The area where nasal bleeding occurs most frequently is the front lower part of the nasal septum – the area where the nasopalatine artery, the septal branch of the anterior sieve artery, the septal branch of the superior labial artery and the branch of the palatine aorta are located, and the mucosa in this area is very thin and easily stimulated by air, resulting in dryness of the mucosa and crusting. Once the nose is rubbed or plucked, it is very easy to damage the blood vessels and cause bleeding. Of course, there are also bleeding from the posterior nostril or the nasopharynx. Rhinorrhea can occur throughout the year. During the season of febrile diseases and respiratory infections (early spring and autumn/winter), inflammation of the nasal cavity and sinuses can lead to rhinorrhea. In seasons when allergies are prevalent, children who rub their noses due to nasal itching may also experience rhinorrhea. However, children with rhinorrhea are more likely to be seen in the hot summer months and in the dry indoor winter months. Common treatment of nosebleeds Nasal bleeding is mostly unilateral and often comes from the front nostril of the bleeding side, or from the opposite nostril and nasopharynx if the amount is large. When a child with rhinorrhea is encountered in the emergency room, the first step is to comfort the parents and the child, minimize the crying of the child, get better cooperation from the parents, and perform local treatment. Local treatment methods Acupressure and astringent method: In clinical practice, it is more common to use acupressure and astringent method or a combination of both for children with small amount of bleeding and no combined systemic diseases, and usually the bleeding will stop by itself in 5-10 min. Cautery method: For the fixed bleeding point can be found, such as YAG laser, radio frequency or microwave to give cautery treatment; the traditional method is to apply silver nitrate or trichloroacetic acid and other chemical drugs for local cautery, but because it is easy to cause mucosal ulceration and cartilage necrosis, now the clinical application has rarely. Caulking method: For children who are ineffective by acupressure and astringent method or children with bleeding diseases such as hematological diseases, caulking method can be used, which is divided into anterior nostril caulking and posterior nostril caulking. The stuffing materials can be divided into absorbable hemostatic materials (such as gelatin hemostatic sponge) and non-absorbable hemostatic materials (such as petroleum jelly gauze, expansion sponge). Nasal endoscopic hemostasis: the bleeding site can be accurately determined and effective treatment measures can be taken to reduce the side damage to the nasal cavity. Others: For severe nasal bleeding in which local hemostasis is not effective, vascular ligation and vascular embolization can be used, which are less frequently used in children because nasal bleeding is relatively easy to stop in adults. Precautions in the process of hemostasis First of all, the side of the nasal bleeding should be confirmed, so that the treatment can be targeted and excessive damage can be avoided. Unilateral nasal bleeding is easy to confirm, but when the child is bleeding heavily, there will be blood coming out of both anterior nostrils or bloody nasal secretions. The side of the bleeding can be clearly identified by suctioning the nasal cavity or encouraging the child to blow the nose, and the side that blows or aspirates the clotting strip is often the bleeding side. For children with rhinorrhea without a history of systemic disease, the treatment should be simple to complex and should not start with the method of stuffing. Children with rhinorrhea in combination with systemic diseases, such as hematologic diseases, should be treated as soon as possible with an effective hemostatic method (anterior or posterior nostril tamponade) because of the presence of abnormal coagulation. After the hemostatic process is completed, do not take it lightly, be sure to check the pharyngeal cavity for active bleeding, if there is no to indicate successful hemostasis; if there are still signs of active bleeding in the posterior oropharyngeal wall, it is necessary to continue to give hemostatic treatment. The duration of non-absorbable plug placement should not exceed 24 h for children with simple nasal bleeding and 48-72 h for children with hematologic diseases and coagulation abnormalities to prevent secondary infection due to prolonged plug placement. For children with heavy bleeding and weakness, pallor and poor response, systemic treatment such as rehydration and intravenous infusion of hemostatic drugs should be given, and vital signs should be observed. When a child with recurrent rhinorrhea is seen in the outpatient clinic, the physician should ask the child’s medical history in detail to find out whether there is any history of systemic diseases, diet and living habits, and the causes of rhinorrhea; observe the child’s spirit and complexion, examine the nasal cavity, check the nasal septum, nasal mucosa, and whether there is secretion or occupancy in the nasal tract, so as to identify the cause of rhinorrhea and give the child and parents the corresponding treatment. At the same time, health education is provided to inform parents of preventive measures. Inform parents of bleeding treatment measures When nasal bleeding occurs at home, parents should remain calm, do not be nervous, try to calm the child, keep the child in a sitting position, squeeze the nasal wing of the bleeding side toward the nasal septum with fingers or pinch the bilateral nasal wings toward the nasal septum with the thumb and index finger, and instruct the child to spit out the blood if there is blood in the mouth, do not swallow it, and at the same time, you can use a cool towel or ice wrapped in a towel to forehead to assist in stopping the bleeding. If the bleeding does not stop after 10 minutes of acupressure, take the child to the hospital quickly; if the child has a bleeding disorder, do not hesitate to go to the hospital quickly to take active measures to stop the bleeding in order to avoid the manifestation of shock due to excessive blood loss. Preventive measures for children with nosebleeds When nosebleeds are under control, applying some oily substances such as sesame oil and olive oil or antibiotic ointment such as gentamycin ointment in the nose can stop itching and can prevent the secretions from drying and hard adhering. Teach children to correct the bad habit of picking their nostrils and avoid rubbing their noses with force. Strengthen nutrition and improve partial eating. Ensure that children can have a balanced diet, correct the eating habits of partiality and gluttony, and supplement with multiple vitamins and trace elements, especially in hot and dry seasons. Increase air humidity. When in dry weather or dry environment, instruct children to drink more water and also pay attention to increase air humidity, such as applying humidifier at home. For children with systemic primary diseases that lead to bleeding tendency, the primary diseases should be actively treated.