Definition

• Injuries to the inside or outside of the nose

Health Information

Types of Nose Injuries

• Bloody nose without a fracture
• Swelling and bruising of the nose without a fracture
• Blood clot of the central wall of the nose. Caution: Risk of cartilage damage and deformed nose.
• Fracture of the nose. Severe fractures of the nose (crooked nose) are usually reset the same day. This requires surgery in the operating room. Most surgeons don’t repair mild fractures until 5 to 7 days after the injury. Caution: A nasal fracture must be re-set before 10 days.

Symptoms

• The main symptom is pain.
• Bleeding from the nose is also common.

Prevention

• Careful adult supervision of young children
• Education of older children about high risk behaviors

Care Advice

1. Nosebleed:
   • To stop a nosebleed, squeeze the soft parts of the lower nose together. Gently press them against the center wall.
   • Do this for 10 minutes to put pressure on the bleeding point.
   • Use the thumb and index finger in a pinching manner.
   • If the bleeding continues, move your point of pressure.
   • Have your child sit up and breathe through the mouth during this procedure.
2. Skin Bleeding:
   • For any skin bleeding, put direct pressure on the wound.
   • Use a gauze pad or clean cloth.
   • Press for 10 minutes or until the bleeding has stopped.
3. Cleansing:
   • After the bleeding has stopped, wash the area. Clean with soap and water for 5 minutes.
   • If a large area, use an antibiotic ointment such as Polysporin. No prescription is needed.
   • Then, cover with a Band-Aid for 1 day.
4. Cold Pack:
   • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
   • Put it on the nose for 20 minutes.
   • Repeat in 1 hour, then as needed. Caution: Avoid frostbite.
5. Pain Medicine:
   • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed.
6. Concerns About Missing a Minor Nasal Fracture:
   • If a swollen nose is the only finding, usually it’s not broken.
   • Even if it’s broken, standard practice is to delay correction for a few days. This allows the swelling to go away. Reason: The swelling interferes with seeing the shape of the nose.
   • X-rays are often not helpful. Reason: Most of the nose is cartilage. Injuries to the cartilage do not show up on X-ray.
   • Looking at the nose after the swelling is gone is preferred. You can usually do this by day 4 or 5. This is the best way to tell if it is fractured. It will look different than it used to. Delayed correction also helps the surgeon better see what needs to be corrected.
   • Caution: If the nose is broken, a surgeon must re-set it. This should be done BEFORE the 10th day.
7. What to Expect:
   • Nose pain and swelling usually peak on day 2.
   • They go away over 3 or 4 days.

Call Your Doctor If

• Pain becomes severe
• Nasal passage becomes blocked
• Shape of the nose has not come back to normal after 4 days
• Signs of infection occur (a yellow discharge, more tender to touch or fever)
• You think your child needs to be seen
• Your child becomes worse

Author: Barton Schmitt MD, FAAP

Copyright 2000-2020 Schmitt Pediatric Guidelines LLC

Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it. The information contained in this handout should not be used as a substitute for the medical care and advice of your pediatrician. Listing of any resources does not imply an endorsement.

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