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Pediatric - Nose Injury

Nose injury

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Does this describe your child's symptoms?

Definition
  • Injuries to the inside or outside of the nose

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 with risk of cartilage damage and deformed nose
  • Fracture of the nose. Severe fractures of the nose (e.g., crooked nose) are usually reset the same day in the operating room. Most surgeons don't repair mild fractures until 5 to 7 days after the injury.
When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Major bleeding that can't be stopped
  • Fainted or too weak to stand
Call Your Doctor Now (night or day) If
  • You think your child has a serious injury
  • Nosebleed that won't stop after 10 minutes of squeezing the nostrils closed and applied twice
  • Pointed object inserted into nose and causes pain or bleeding
  • Skin is split open or gaping and may need stitches
  • Severe pain
  • Very deformed or crooked nose
  • Clear fluid is dripping from the nose and not due to crying
  • Breathing through the nose is blocked on one side or both sides
  • Age under 1 year old
  • Nose looks infected (fever, a yellow discharge, redness)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Shape of the nose has not returned to normal after 5 days
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts)
Parent Care at Home If
  • Minor nose injury and you don't think your child needs to be seen
HOME CARE ADVICE FOR MINOR NOSE INJURY

  1. Nosebleed: To stop a nose bleed, squeeze the soft parts of the nose against the center wall for 10 minutes to apply pressure to the bleeding point.
  2. Skin Bleeding: For superficial cuts or scrapes, apply direct pressure for 10 minutes with a sterile gauze to stop any bleeding.
  3. Cleansing: Then wash the area with soap and water for 5 minutes. If a large area, apply an antibiotic ointment and cover with a Band-Aid for 1 day.
  4. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen as needed for pain relief.
  5. Concerns About Missing a Minor Nasal Fracture:
    • A swollen nose usually is not broken
    • If it is broken, standard practice is to delay correction until the swelling is gone
    • The swelling interferes with diagnosis and treatment
    • It's hard to diagnose a broken nose because of nasal swelling (most swollen noses have no fracture).
    • X-rays are often not helpful because injuries to the cartilage do not show up (most of the nose is cartilage).
    • Looking at the nose after the swelling is gone (day 5 to 7) is the best way to tell if it is really fractured. It will look crooked or different than it used to. Delayed correction also helps the surgeon better see what he is changing.
    • In summary, it's safe to delay the treatment of a mild nasal fracture.
  6. Call Your Doctor If:
    • Pain becomes severe
    • Nasal passage becomes blocked
    • Shape of the nose has not returned to normal after 5 days
    • Signs of infection occur (a yellow discharge, increasing tenderness or fever)
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 6/24/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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