Heather Finlay-Morreale, MD, Pediatrician, University of Massachusettes Memorial Medical Group
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.
Read More From Patientslounge
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.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: My 3 year old autistic son broke his nose falling off the couch the other day and he now has a dried blood clot in his nasal passage that’s giving him issues breathing from that one side. How can I help safely remove it to help him breath better? He won’t let me touch his nose at all and I tried with a damp q-tip while he was sleeping and it’s in there solid. Right around where he busted it. What could I do to help my poor boy?
Answer: Anytime an incident involves breathing or a serious medical condition, please seek professional medical treatment as soon as possible.
© 2012 LauraGSpeaks
Amber on June 20, 2019:
Hi, my daughter had got hit in the nose a while back. It didn’t get black and blue but she said it hurt so we iced it. I am now noticing it seems to be a little crooked and off to the one side. She isn’t have any symptoms from this. Should I have it looked at?
adeebeh on December 14, 2017:
My daughter hit nose first in gym . still crooked and tender 4 yrs later
Alyssa on November 13, 2017:
I fell and hit my nose hard and it started bleed after awhile it stop and haven't bled since it's been 3 day since this happened but my nose is still in pain and a little bit swollen I haven't down anything for it I just started putting ice on it today on the 3day I can breathe normal just painful and little swollen. Just wanna know what I should do?
Pvk on March 29, 2016:
my daughter fall down on a stroller after that her nose bleed and swallow it is ok she is one year old after few minute nose bleeding stop m very worried
LauraGSpeaks (author) from Raleigh, NC on July 27, 2012:
Hi Jamie. Apply some ice and monitor your son's nose. I bet he will be fine. Good luck!!
Jamie Brock from Texas on July 27, 2012:
Thank you for this info.. a little while ago my 4 year old son just smacked his nose right to the floor and the blood was pouring out. It scared me because he hit it so hard that it seems its likely he could have broken it. I was trying to find something about it online and ran into your hub. I feel a little better now. It's not bleeding anymore and doesn't seem to be too swollen, at least not yet. Again, thank you :)
LauraGSpeaks (author) from Raleigh, NC on June 27, 2012:
Ragged, that is useful info regarding using vitamin C for nosebleeds. I hav not heard of that. thank you for sharing..
Bev G from Wales, UK on June 27, 2012:
Useful info. Thanks. No busted noses but all three of my kids have had many nosebleeds. We have learned how to deal with them and they seem to lessen as they get older. The best way to stop them, we discovered, is a couple of Vitamin C tablets and sips of cold water. However, if we give Vit C daily to prevent them, A. it doesn't and B. it's then ineffective when they do get a nb.
chrissieklinger from Pennsylvania on June 24, 2012:
Great hub, many times with things like this you debate going to the doctor. My daughter has thought she has broken all kinds of bones in her body but we always wait a day and watch for swelling and bruising.
Angela Michelle Schultz from United States on June 23, 2012:
This is such an important topic, and I'm glad you shared it!
LauraGSpeaks (author) from Raleigh, NC on June 23, 2012:
Hi TahoeDoc. Thank you for sharing your experience and your valuable information regarding a septal hematoma. I appreciate your comments.
TahoeDoc from Lake Tahoe, California on June 23, 2012:
Good timing on this hub. I was on call just last night when I got a call to come in to the hospital. A child got hit in the nose with a hard object. He had only a trickle of blood from the nose, but it was swollen and he thought it was harder to breathe through it.
In his case, the diagnosis was a septal hematoma. This can become a surgical emergency or at least needs to be drained in the operating room (usually) urgently. In this condition, it may not seem like the injury is that bad because the blood collects in the septum- the cartilage that runs down the middle of the nose. After the blood collects there, it can cut off circulation to the septum causing death of the cartilage tissue. It can also predispose to infections there.
Nose injuries with swelling inside (obvious or expected) the nose, usually detected as obstructed breathing as you listed above, should be evaluated immediately by a doctor rather than be treated at home, to rule out this emergency. This septal hematoma is more of an emergency than a broken nose, usually. Just wanted to reiterate that since I saw it in the last day. :) Good job! Voted up and thanks for publishing useful and reliable medical information.
MikeNV from Henderson, NV on June 23, 2012:
Good information and personal experience. Like to see this type of hub. Voting up.
LauraGSpeaks (author) from Raleigh, NC on June 23, 2012:
Judi Bee, I do fine with bloody noses, but any more than that, I need help too! Janis, you are right, deviated septums can cause all kinds of sinus related issues. I am glad you got an accurate diagnosis for your daughter.
Janis Goad on June 23, 2012:
Great hub. The title is a real gripper, and caught my attention immediately.
My daughter had a deviated septum from birth, which we did not diagnose until her late teens when we finally got a referral to an ENT specialist about her constant ear and sinus infections.
If the nose is broken and heals crooked, it can contribute to recurring sinus infections, so it is worth getting X-rays and finding out.
Judi Brown from UK on June 23, 2012:
Really useful advice, but in my case there is only one response to any injury involving blood - call a responsible adult. I tend to cope for about two minutes before having to lie down myself, I really am no good with gore. Actually, just reading this has made me feel woozy. Voted up though!