I see many children who have the same symptoms as your 4 year old!
In 90 per cent of the cases, there is an allergic reaction to something in the air that your child is breathing in all night long and in the house. He thus is likely to sneeze, have some nose block or itchy nose at night and in the morning.
He may dig or rub his nose more often, or unconsciously at night, thus get the nose bleeds. There is a blood vessel that ends really close to the entry of the nostrils, easily traumatised by tiny fingers or if tissue is stuck up the nose to stop the bleed.
After examining the nose, I may suggest a skin prick test to test for the common air-bone allergens like dust mites, book mites, mould, cat, dog, cockroach, tree and grass pollens in Singapore.
We do this in clinic, even young babies can tolerate this well, and the results are known in 20 minutes. We can then advise you on how to control the offending allergens. In severe cases, medications or immunotherapy can help.
If there is no allergy, I may then suggest a flexible nasoendoscopy of the nose to exclude any anatomical variations like a crooked bone or polyps in the nose that may increase the risk of bleeding. Occasionally, simple blood tests are done to exclude a blood coagulation problem.
Kind regards,
Dr Lynne Lim
