Back to School – Nosebleed Management

A message from Cure HHT Chief Medical Officer, Scott Olitsky, MD

As children begin to return to school, now is a good time to talk to your school nurse and educators about HHT and nosebleeds.  Nosebleed severity can vary widely among family members and it should always be remembered that the presence and/or severity of HHT associated problems are not correlated to the severity, or even the presence, of nosebleeds.

Although nosebleeds tend to get worse with age, many children will begin to experience nosebleeds during their school aged years and therefore it may be helpful to speak to school nurses to allow them to understand the nature of nosebleeds in children with HHT.

Most families with HHT are already well versed in managing nosebleeds and often are not overly concerned when their child has a nosebleed.  Often the best first words of advice for people at school is to tell them not to panic when your child has a nosebleed.  There is a good chance that a teacher or nurse may be more worried about your child’s nosebleed than they are.

If your child does have a nosebleed at school some suggestions that may be helpful in the management may include:

  • Do not panic. Explain that your child has HHT and that they are prone to frequent nosebleeds and they are often able to manage them on their own (depending on their age and severity).
  • Pinching the nose may be helpful for some people for mild nosebleeds but for other people the manipulation involved in pinching may aggravate their nose and cause the bleeding to worsen.
  • Telling your child to tilt their head back may stop the blood from dripping out of their nose but may send it down their throat and if they swallow enough blood could make them nauseous.
  • Allowing your child to place something in their nose to tamponade the bleeding may help stop the bleeding.  School personnel may not be allowed to perform this “procedure” themselves due to school policies.  If that is the case, many children will have experience in doing so and can be allowed to do it themselves.  If that is the case, lubricating the packing so it can be removed without restarting the bleeding is preferred.  Cotton balls work well for this purpose, but tissues can be used as well.

Although the bleeding may persist for some time, it is uncommon for a young child to bleed enough to require an urgent trip to the doctor or emergency room and allowing for some time to pass will be sufficient for almost all nosebleeds that occur in the school setting.  If the nosebleed continues for longer than what is typical for your child, a parent who is familiar with the situation can usually manage the problem if available.

While most children with HHT will experience nosebleeds at school, conservative measures and time is all that is needed in most cases.  It is important to discuss your child’s specific history with your school nurse to let them know what is typical and when additional steps may be warranted if the situation appears to be atypical for your child.