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Facts About Bleeding
A child is hurt and bleeding; what should you do? It is not uncommon for childcare professionals to encounter a bloody nose or a scraped knee when caring for children. Bleeding always requires immediate care, but most of the time it is more alarming than it is serious.
As caregivers, your job is to give first aid--this means stop the bleeding and give immediate care to the child. Any time first aid is needed for a child, the parent should be notified. Even small cuts may require stitches, and this must be done quickly to assure good healing. A physician can determine if additional treatment, such as sutures, antibiotics, or a tetanus shot, are needed. Always use standard precautions when treating bleeding--wear protective gloves and clean any spills with a bleach solution or other appropriate cleaner and disinfectant.
Nosebleeds
A very common source of bleeding is the nose. Just inside the nose, behind the soft nostrils, are blood vessels that are very close to the surface. They are usually the source of bleeding in children’s nosebleeds.
What should you do for a nosebleed? Have the child sit up and lean the head slightly forward; then pinch the soft nostrils firmly, and push toward the face. Hold for 15 minutes and release. Usually, this is enough to stop bleeding. If not, repeat for another 15 minutes. If the bleeding does not stop, get medical help.
It is equally important to know what not to do for a nosebleed. Do not put the child’s head between his knees; that will increase the child’s blood pressure. Do not have the child lie down; this allows blood to run down the throat. Do not stuff gauze in the nose. Finally, do not let the child blow his nose once the bleeding stops.
Occasionally, a child with a nosebleed will swallow blood that has gone down the throat. This is especially true if the nosebleed has been going on for a while and the child has been lying down. The child may vomit the blood--a very disturbing occurrence! Just remember that the blood is actually from the nose, not the stomach, and is not a cause for alarm.
Injuries to the Skin
Abrasions, or scrapes, are the most common and the least serious form of injury that can cause bleeding. Wash the injured area gently with warm, soapy water then blot gently with gauze and put a non stick bandage over the wound. A mild abrasion, which has stopped bleeding, can be left to “air dry.”
Cuts, or lacerations, are somewhat more serious. If the cut is small, simply use an adhesive bandage. For larger cuts, put direct pressure on the cut and hold it firmly. Cover the cut well with sterile gauze. If the injury is to a finger or wrist, etc., wrap gauze around the injured area several times. Then, while keeping the gauze snug, tape the end onto the dry part of the bandage.
If blood later oozes through the dressing, do not remove the dressing because this will disrupt the clot formation. Simply cover it with another rolled gauze dressing, also pulled taut.
Mouth Injuries
There is a little membrane under the tongue called a frenulum. There are similar membranes between the upper lip and the gum, as well as the lower lip and gum. These membranes can become torn, and bleeding is often profuse lasting several minutes. It can be a bit scary, but it is rarely serious. You should attempt to put pressure on the bleeding site, but usually the bleeding will stop within minutes.
Another common mouth injury is a bitten tongue caused by a fall where a child hits his or her chin and at the same time bites the protruding tongue. Such injuries are painful, but bleeding stops rather quickly. The tongue is often bitten simultaneously by the upper and lower teeth, leaving the appearance--with cuts on the top and bottom--that it has been bitten through, entirely. This is rarely the case, however. Bites (or other lacerations) of the tongue heal well and usually do not require sutures. Infections of the bitten tongue are rare, but when they occur, medical attention is required.
Scalp Injuries
The scalp is a bit unusual for two reasons: it is very well supplied with blood vessels; and the edges of a cut on the scalp tend to pull apart, aggravating the bleeding. However, applying steady pressure directly on the cut usually stops the bleeding.
Other Bleeding
Most bleeding occurs from capillaries, the smallest blood vessels. More serious is a cut to an artery or vein. Arterial bleeding is the most serious. Blood from an artery is bright red and may come out of a laceration or other type of wound with some force. Spurting is typical, although in the excitement of the moment it may not be noticed. Once again, remember the principle of sustained direct pressure using a wad of gauze held in your gloved hand. This will stop almost all bleeding.
If it can be done conveniently, the bleeding part of the body should be elevated to a few inches above the level of the heart in the center of the chest. If the wound is in the leg, the child should lie down with the leg elevated. If the cut is on the arm, arrange for the child’s arm to be propped upon a bookshelf, or table or something above the level of his heart as he is sitting down. This simple step can significantly help control bleeding.
Internal bleeding can be very serious but also is very rare. A particular injury to watch out for is falling upon a bike or tricycle handlebar or similar object, causing a sharp blow to the abdomen. If such an accident happens and the child complains of pain, medical help should be obtained immediately. Remember, young children do not always express pain as we expect; a child may have a significant injury but not cry or complain of severe pain.
Donald Palmer, MD
Alabama Chapter, American Academy of Pediatrics
INTERNET RESOURCES
Check these web sites for information on bleeding and first aid for children:
A sample injury reporting form, www.childhealthonline.org
RESOURCES
American Red Cross, 2025 E St., NW, Washington, DC 20006; 202-303-4498; www.redcross.org
American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 847-434-4000; www.aap.org
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