What to Do When Your Child May Have a Broken Nose
It can happen in an instant: Your child is hit in the nose with the football, falls down and lands on their face, or even runs into a doorknob nose-first. When my daughter got smacked in the nose with a basketball thrown at close-range, her nose was gushing blood.
Even though the bones in young childrens' noses are harder to break, there are numerous situations that can happen to kids that leave parents wondering if their child has broken their nose. What to do? Thankfully, kids are resilient and heal rather quickly. Here is what you should do if your child runs into the house screaming in pain with blood gushing from the nose.
How to Stop a Nosebleed in a Child
"I advise bending forward a bit, pinching the nose, and not looking or unpinching for at least 15 minutes," says Dr. Heather Finlay-Morreale, a pediatrician in Sterling, MA.
When a child may have broken their nose, there will usually be some (or a lot of) blood. The first thing to do is get the nosebleed under control.
- Have your child sit down, lean slightly forward, and hold their head upright. Don't let them lie down, as this will cause blood to run down their throat which can cause nausea and vomiting. Note that blood draining down the throat can cause choking and dark-colored stools or diarrhea the next day, says Jessica DeLuise, a physician's assistant in Philadelphia.
- Place gauze or tissues on the nose and gently pinch the nostrils closed with minimal pressure. Sometimes children prefer to do this themselves, especially if they are upset and in pain.
- Hold tissues or gauze in place for 15 minutes without removing.
- Applying an ice pack to the lower forehead can help.
- After the nosebleed has stopped, your child should remain seated to prevent the bleeding from starting up again. It's a great time to watch a movie for a while and settle down. Do not clean out the nostrils for several hours as this may dislodge blood clots and cause bleeding to return.
Signs of a Broken Nose in Children and Toddlers
You can't always tell if a nose is broken just by looking at it. Swelling can make it hard to tell if the nose is crooked, but aside from a change in shape here are some of the signs of a broken nose:
- Tenderness in the facial area surrounding the nose
- Bruising under the eyes (black eye)
- Obviously crooked nose
- Crunching or creaking noise when touching nose
- Difficulty breathing through nose
When to Go to the Doctor for a Nose Injury
"Typically broken noses can be set, if needed, 3-5 days after the fracture when the swelling has decreased," says Dr. Finlay-Morreale.
Several things, however, may require immediate attention at a hospital.
- Major bleeding that can't be stopped. A septal hematoma, if present, needs to be drained to avoid permanent damage
- Nose is severely deformed or obviously crooked.
- Breathing is restricted.
Concussion or associated injuries to other bones in the skull require immediate evaluation at a doctor's office or ER. Symptoms of these types of injuries include:
- Clear fluid leaking from the nose.
- Jaw misalignment.
- Inability to move eyes in all directions normally.
- Vision problems.
- Speech, gait, or thinking are “off” (indicating concussion)
What Is a Septal Hematoma?
The septum is the firm tissue that separates your nostrils. A septal hematoma is when blood collects in the septum, making it squishy. Symptoms include trouble breathing, congestion, bruising, and a changed shape of the nose.
Septal hematomas can happen when the nose is injured. If you suspect a hematoma, apply ice to the area and take your child to the doctor. The blood may need to be drained from the septum.
"An untreated septal hematoma permanently destroys part of the wall between nasal passages and requires surgical treatment," says Dr. Finlay-Morreale.
Can a Baby Break Their Nose?
Baby bones are more flexible, but if a baby has a bad fall it's possible for the upper bone in the nose to fracture.
Broken noses are complicated for babies because babies can't breathe through their mouths and so will have trouble breathing. Contact your doctor if you think your baby has a broken nose.
Can an X-Ray Diagnose a Broken Nose?
Although X-rays can be performed, the nose is mainly cartilage and injuries to cartilage do not show up on X-rays. X-rays can be useful, however, to determine if the bridge of the nose or portions of the cheekbone are fractured.
How to Treat a Child's Nose Injury at Home
- After stopping the nosebleed, apply ice to the nose area. A bag of frozen vegetables wrapped in paper towels works great for this. Ice the nose for at least 15 minutes to reduce swelling. You can continue to apply ice treatments over the next several days.
- Over-the-counter pain medication, such as Tylenol, can be given for pain. Remember never to give aspirin to kids under twelve due to the risk of Reyes disease.
- Sometimes it is also helpful for the child to sleep propped up with pillows so their head is elevated.
- Your child's nose may remain sore and swollen for several days. Keep them from engaging in excessive physical activity, both to avoid another blow to the nose and to help the injury heal.
Common Causes of a Broken Nose
According to the Mayo Clinic, the most common causes of a broken nose in children are:
- Sports injuries, especially football and hockey
- Motor vehicle accidents
- Physical altercations (in older children)
What Your Doctor May Recommend
If the nose still looks crooked after the swelling subsides, an ear nose and throat (ENT) specialist can reset or realign the nose in an office procedure using anesthesia. Typically, if there are no issues with breathing and the sinuses are not affected, this procedure is not done unless it is desired for cosmetic purposes.
Medical Treatment for a Broken Nose
If you do take your child in to see the doctor and there is still some bleeding, they may pack the child's nostrils with gauze until the nosebleed stops.
They may straighten a simple fracture and set it using tape.
In some cases, for more complicated breaks, surgery is required to move bone or cartilage back into place.
What Are the Risks of Not Treating a Broken Nose?
Dr. Finlay-Morreale cautions that:
- If clear fluid is leaking from the nose, this indicates an opening from the nose into the brain. This requires surgery. "Left untreated, this condition can cause life-threatening infections."
- Untreated concussion symptoms, if a bleed is occurring in the brain, unchecked can lead to death.
- Associated facial bone fractures can require surgery to repair.
In addition, if there is any pain with eye movement or change in vision, this could indicate eye muscle injury, which can lead to permanent damage if left untreated, says Jessica DeLuise, a physician's assistant in Philadelphia.
What Is a Deviated Septum?
A deviated septum is a potential complication of a nose fracture. It occurs when the tissue that separates the nostrils is displaced or moved, making the breathing passage more narrow.
In the short term, medications like decongestants and antihistamines can help manage a deviated septum, but surgery is required to correct the condition.
My Daughter's Experience
My daughter got smacked in the nose with a basketball thrown at close range. The nosebleed stopped after about 10-15 minutes. I applied ice to the top of her nose as I could see lots of swelling. I gave her Tylenol for the pain and kept her activities limited for the rest of the day. I suspected her nose may be broken due to the amount of pain and swelling she had.
The swelling continued for several days. On day eight, her nose looked slightly crooked to me. On day nine she had two bad nosebleeds, just from running. She encountered no additional bumps to the nose. That was it.....we were off to the doctor. I was convinced her nose was broken. I was upset thinking my daughter had broken her nose and that I had waited so long to take her to the doctor.
Turns out the doctor said he wouldn't have treated her nose any differently had I taken her in earlier. He said many people have fractures to the nose and choose not to treat it. The doctor acknowledged the slight crookedness and noted how tender her nose still was. He also thought she still had a good deal of swelling.
His first question was if she had difficulty breathing out of her nose. Since that answer was no, he said there was no medical reason to have her nose reset. He gave me the option of having an X-ray performed just to rule out any fracture in the bony part of the nose, or a deviated septum. The mom in me chose to have an X-ray done, even though I knew it likely wasn't necessary. As expected, the X-ray was inconclusive. However, It did rule out a fracture in the bony part and the septum of the nose.
The doctor advised me to continue to apply ice every day until the swelling was gone. Once the swelling was completely gone, he said, we could decide if we wanted to go to an ENT to have it evaluated and possibly reset if it was still crooked. Eventually, the swelling went away, but it took much longer than I thought. The crookedness subsided with the swelling.
Heather Finlay-Morreale, MD
- The article has been modified since this review was written.
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