Chronic nosebleeds

A Nosebleeds are common in children, especially those under 16. They are often the result of nasal trauma or dryness, picking at a crust inside the nose, juvenile angiofibroma (a benign growth at the back of the nose or upper throat) or a blood-clotting disorder (Postgrad Med, 1987; 81: 217-24). Bleeding may be due to damage to the mucosal lining of the nose affecting the blood vessels or altering blood coagulability (Emerg Med Aus, 2004; 16: 428).

In most cases, nosebleeds are not difficult to treat. They usually stop by themselves on pinching the bridge of the nose.

However, some children suffer from repeated nosebleeds or, to use its clinical name, ‘recurrent idiopathic epistaxis’. The cause of this condition is not known and there is no general consensus as to how best to treat it (Cochrane Database Syst Rev, 2004; 1: CD004461).

The most commonly used treatments are silver-nitrate cautery (where heat is used to seal the nasal blood vessels) and antiseptic cream. In some cases, the two are used together.

Yet, although clinical trials show that antiseptic cream is effective in treating nosebleeds, as is cautery, it’s not clear whether or not either is better than no treatment at all.

For example, in one trial where 64 patients with recurrent nosebleeds were given either Naseptin antiseptic nasal cream alone or in combination with silver-nitrate cautery, no statistically significant difference was found between the two treatments. The authors concluded: “Silver nitrate cautery offers no added advantage to the management of simple epistaxis in both children and adults” (Clin Otolaryngol Allied Sci, 1999; 24: 228-31).

In a review of three studies - one comparing Naseptin cream with no treatment, another comparing Vaseline petroleum jelly with no treatment and a third comparing Naseptin with silver-nitrate cautery - again, there were no statistically significant differences among any of the treatment groups. The authors concluded that high-quality trials are needed “to assess the relative merits of the various treatments currently in use” (Cochrane Database Syst Rev, 2004; 1: CD004461).

But there is yet another reason not to treat your child with Naseptin as it contains peanut oil. So, apart from being dangerous to children who already have a peanut allergy, using the cream can itself induce a nut allergy (N Engl J Med, 2003; 348: 977-85).

You may also wish to avoid cautery, too. Although no serious adverse affects have been seen, children receiving the treatment report that it is very painful even with local anaesthesia (Cochrane Database Syst Rev, 2004; 1: CD004461).

But, as usual, there are other, natural ways to treat, and maybe even help prevent, nosebleeds. Supple-menting with various nutrients and herbs can help strengthen capillaries, thus reducing the frequency of nosebleeds. For example:

* vitamin C may help. Capillary fragility, leading to bleeding and easy bruising, may be a sign of vitamin C deficiency, according to American nutrition expert Dr Melvyn R. Werbach (Townsend Lett Docs, 2005; August-Sept: online). So, taking vitamin C can strengthen capillaries and may thus reduce chronic nosebleeds.

* flavonoids (water-soluble plant pigments) can also help recurrent epistaxis by bolstering capillaries and other connective tissue; some can even act as anti-inflammatories and antihistamines.
- anthocyanoside flavonoids can also protect against fragile capillaries (Minerva Med, 1977; 68: 3565-81). The European bilberry (Vaccinium myrtillus) is a rich source of these flavonoids.
- hesperidin, the predominant flavonoid in oranges and lemons, can help capillary fragility. A diet deficient in this flavonoid has been linked with abnormal capillary leakage (Phytother Res, 2001; 15: 655-69).
- hesperidin with vitamin C has also been investigated. When patients with rheumatoid arthritis and increased capillary fragility received either hesperidin, vitamin C or a combination of the two, the greatest improvement was seen in those taking the combination.

According to Dr Werbach, a reasonable dose of hesperidin with vitamin C is 25-200 mg four times a day (Townsend Lett Docs, 2005; August-Sept: online).

* tienchi or sanchi ginseng (Panax notoginseng) has been used for centuries in China for trauma and bleeding conditions. In one study - albeit in rats, so it may not apply to humans - it halted bleeding when applied topically (Pharmacotherapy, 2001; 70: 773-7). For more information on this type of ginseng, see http://healthyherbs.about.com/od/monographs/p/tienchi.htm. Nevertheless, if you wish to treat your son with this powerful herb, it may be best to visit a traditional Chinese herbalist.