Nose Bleeding In Children: Why?

It can be a worrying experience if your child has bleeding from nose (epistaxis). However, most of the time the nose bleeding is not caused by serious problems.

Nose bleeding usually occurs on one side of the nostril. It is commonly due to injury to the inner lining (mucosa) of the front part of the nose, such as:

• nose picking (esp with sharp fingernails)
• nose blowing & rubbing
• nose inflammation / infection
• foreign body in the nose
• nose trauma (eg. from a blow on the face)

The bleeding point is most likely at the front part of the nose septum (Little's area) where the blood vessels are most abundant. You may see this area if the nose bleeding is not too profuse. 

       Little's area

When the bleeding occur, sit the child upright and tilt his/her head forward to prevent the blood from flowing backwards into the mouth. Then pinch the nose with your thumb and index finger for at least 5-10 minutes to compress the bleeding point at Little's area. If the bleeding does not stop and you are worry, it is wise to bring your child to a doctor.

Nose bleeding can be recurrent, especially in children with underlying allergic condition such as allergic rhinitis. Besides, dry air or dry weather can cause nasal mucosa irritation and increase the chance of nose bleeding.

Very rarely, nose bleeding in children can be caused by more serious disorders especially when:

• there are bleeding elsewhere other than the nose (gum bleeding, bruises, bloody stool etc)
• the bleeding does not stop or takes a longer than usual time to stop
• very frequent nose bleeding episodes

A few more serious causes of nose bleeding in children include:

• blood coagulation disorder (congenital or acquired)
• low or abnormal platelet function
• blood cancer (leukemia etc)
• nose tumour

Nose bleeding in children is usually harmless. If you are in doubt, please consult your doctor for confirmation.

Children With Foot Pain At Night: Growing Pain?

It is very worrying for parent whose child suddenly wakes up in the middle of the night crying and complaining of leg or foot pain, and it recurs few other nights. Young children may not describe the pain and locate the pain accurately, this makes the parent even more anxious.

It's not easy to diagnose leg/foot pain in children. The most important thing to do is to rule out serious illness or disorder associated with the pain.

There is a condition often referred to "growing pain", which is completely harmless and is a diagnosis of exclusion. The typical features for a growing pain are:

• Pain in foot or leg (one or both sides) mostly occurs at night only
• Occurs intermittently and not on every night
• Pain lasts for few minutes and the child can go back to sleep
• No swelling, redness over the pain area
• Not worsening by touching/pressing the pain area
• Completely well in the morning, without pain and limping

By using our common sense, if it is something more serious, it should be:

• Pain during both daytime and night time, almost everyday
• Pain getting worse and worse with time
• There is swelling or redness at the pain area
• The child resists someone from touching the pain area
• The child has other symptoms other than pain
• The child has limp and discrepancy in leg length

There are a few conditions to consider for foot or leg pain in children

Injury (bony fracture, ligament sprain, muscle strain)

• does the child has recent fall or trauma?
• pain exists all day long, not just night time
• there can be swelling, skin lesion and especially pain to touch
• limping is likely

Arthiris (juvenile idiopathic arthritis)

• typically having morning stiffness 
• commonly affects more than one joint
• can occur in any body parts
• pain may continue in daytime
• may have swelling in the joints
• may have other symptoms such as fever & skin lesion

Tumour (benign or cancer)

• pain during day and night time, though typically worse at night
• pain wosening with time
• can feel the swelling in later stage
• may have limp and discrepancy in leg length
• more common on long bones - femur, tibia (not foot)

Kohler's disease

• avascular necrosis of a bone in the foot (navicular bone)
• rare and benign condition
• may have pain during day and night time
• may have swelling

Thus, if your child with foot pain (either one foot or both feet) at some nights and is completely well during the rest of the day, with no swelling or deformity, then it is likely a "growing pain". It is also important to check whether your child has a normal foot arch.

Growing pain is believed to be a muscular pain and more common in age 2-8 years old. Though it is harmless, it is really painful to the child. You can massage or stretch the pain area or apply warm towel to try to relieve the pain. If the pain is intense, analgesics can be given for short term relief. 

However, it is possible that there is actually no pain but the child is just trying to seek parent's attention.

If you are not sure what is happening to your child with foot/leg pain, please consult your doctor. The doctor is likely to ask you the questions above and examine your child. In some cases, an X-ray may be required.