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Bleeding in a child is always concerning and causes moments of panic among parents and householders. Every 4 out of 10 children experience one or more bleeding symptoms during the first 5 years of life. Bruising and epistaxis are the most common bleeding complaints witnessed on a daily basis in my outpatient practice. Bleeding can be simply classified as, external, internal, and occult (invisible) blood loss.
Not all bleeds are dangerous!!! However, it is often a diagnostic challenge to identify a bleeding disorder and ascertain if it needs any specific evaluation so that appropriate therapy can be provided.
Clues For a Bleeding Disorder
1. Recurrent and spontaneous (non-traumatic) bleeding.
2. Multiple site bleeding, e.g., external and internal bleeding at the same time.
3. Family history of bleeding symptoms.
4. Onset: early in life.
5. Nose bleed—not controlled at home; needs intervention or packing.
6. Prolonged bleeding. Eg: bleeding after tooth fall > 5 minutes.
7. Uncommon site: back, flank, abdomen, skin.
8. Deep bleeds (muscle hematomas, joint bleeds, and intracranial bleeds).
Causes Of a Bleeding Disorder
In simple terms, Bleeding Disorder in Children can be caused by defective platelets or a defective clotting system.
Platelet disorders include ITP (immune thrombocytopenia), aplastic anaemia, and platelet function disorders (Glanzman thrombesthenia, Bernaud Solier syndrome).
Clotting disorders include hemophilia, Von Willebrand disorder, and DIC (disseminated intravascular coagulation).
Common Sites of Bleeding
1. Over bony prominences (shin, elbow, forearm, and forehead)
This is very common in the toddler age group and is mostly after a trauma.
2. Nose bleed (epistaxis)
Nose bleed is always a panic site for a parent.
Very commonly associated with nose picking, injuries with sharp objects, common cold, and violent blowing of nose.
It is often self-limiting and usually resolves as the child grows.
Few people are habitual nose bleeders, and it can be recurrent and seasonal.
3. Blood in stool
Sometimes streaks of blood appear in stool.
Constipation and passing hard stool is the usual reason and resolves with proper toilet training.
In an older child or adult, blood in stool should be evaluated for the cause.
First Aid At The Time Of a Nosebleed
1. Sit up and lean slightly forward.
2. Pinch the nose just below the bony part using your thumb and index finger.
3. Hold the pinch for "no less than 5 to 10 minutes" straight without looking.
4. After 5–10 minutes, release the pressure. If the bleeding has not stopped, repeat pinching your child’s nose for another 10 minutes.
5. You may also put an ice pack on your child’s nose after the bleeding has stopped to constrict the blood vessels in the nose.
6. Do not forcefully sneeze or remove the formed clot
Evaluation And Treatment
In cases of bleeding, seek medical advice from an experienced pediatric haematologist in yeshwanthpur to understand the reason behind. Most of the time, a good history and examination may be sufficient for your doctor to know the cause. However, a few simple tests (investigations) may be necessary to diagnose the patient appropriately.
If the haematologist diagnoses a bleeding disorder, then the following measures are advisable:
What You Should Do / Should Not Do
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Before buying any prescription or over-the-counter medications for your child, consult your doctor.
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Avoid drugs that affect bleeding, such as aspirin and ibuprofen. Do not use rectal suppositories.
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Use a soft-bristled toothbrush or finger brush to clean your child’s teeth.
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If your child hurts himself or cuts himself, clean the area well and apply firm pressure with a clean cloth for at least 5 minutes.
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Check with your doctor before any vaccination, dental check-up, or dental procedure for your child.
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Prevent constipation. If needed, take a prescription for laxatives or stool softeners.
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Avoid strenuous exercise and contact sports.
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Do not blow your child’s nose with too much force.
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At the onset of menstruation, she may have prolonged or heavy bleeding. If so, consult your doctor. She might be advised to take oral contraceptive pills during her menses.
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In the future, during childbirth, there is a possibility of heavy bleeding.
Dr. Vinay Munikoty Venkatesh
Manipal Hospitals, Yeshwanthpur, Bangalore
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