Should I be concerned if my 4 year old has a dry cough and frequent nosebleeds?
My 4 year old son has an intermittent dry cough throughout the day. He also frequently has nosebleeds in the morning, about twice a week. This usually happen when he wakes up and sneezes. Should I be concerned about the nose bleed or dry cough?
Dear Miss Loo,
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.
Dr Lynne Lim
Nosebleeds in children are most often due to prominent blood vessels on the front part of the nasal septum (wall that separates the nose into right and left sides) that have burst. This can be spontaneous or triggered by certain activities such as frequent nose digging or violent sneezing. He may alsonbe suffering from Rhinitis (sensitive nose).
If the nosebleeds happen twice a week and he has troublesome sensitive nose, you should consider bringing him to see an ENT Specialist. If the cause of the nosebleed is due to enlarged blood vessels on the front part of the nasal septum, it can be easily sealed off using Silver nitrate sticks.
His sensitive nose can be treated with nasal steroid sprays and antihistamines. For more information on nosebleeds and sensitive nose, do check out my previous articles and answers on DxD (below are the links):
Hope this helps and all the best!