We’ve gotten a lot of requests to write a post about nosebleeds so I thought I would cover some of the basics. As we’re going along remember this: While scary and annoying, most nosebleeds don't point toward anything concerning.

What causes nosebleeds?

If you are like me, nosebleeds will never be the same after Eleven and Stranger Things. But don't get things upside down on the actual cause of your child's bloody nose.

The nose has tons of blood vessels that go to it...and the tissue inside the nose is very fragile and can easily crack and bleed.

Anything that causes the tissue to be dry can lead to increased risk for nosebleeds, especially dry and very cool or warm air (winter and summer). Conditions which lead to nasal inflammation (especially nasal allergies) can also be a factor.

Ultimately, the most common trigger to a bleeding is nose picking but extreme heat, activity and stress can also be a factor. Yes, your kids pick their nose. Every kid picks their nose. I promise. Other common triggers are blowing and suctioning.

There are a few more unusual causes of nosebleeds that should be considered if the nose bleeds are consistent over time:

1. Structural problems - An abnormal bump or growth can be more prone to injury.
2. Bleeding problems - Children who have problems with blood clotting can be more prone nosebleeds.
3. Object stuck in the nose - Sometimes kids put stuff in their nose. Symptoms are usually one sided bleeding and a foul smell from the nostril.

How do you stop a nosebleed?

Pinch it. Pack it. Head up. Head down. What is the right thing to do?

There's no reason to tilt the head back or to lie down. This only increases the amount of blood that is traveling down the back of the throat and can lead to coughing or vomiting blood later.

• Have your child sit or stand and slightly lean forward and breathe through their mouth.
• Firmly pinch your child nose in the soft part just below the bony ridge.
• Hold pressure at that location for 10 minutes. Don't check. Seriously, if you're reading this now, don't check.
• If the bleeding does not stop, repeat again for 10 minutes.
• If the bleeding does not stop, continue holding pressure but get ready to head in to be checked out by a doctor.

When should you be concerned about nosebleeds?

It can be difficult to know what is normal and what is concerning with nosebleeds.

Here are some indications that you should probably see your doctor:

1. An individual nosebleed that doesn't resolve after  two attempts to control bleeding for 10 minutes.
2. Nosebleeds are happening more than 2-3 times per week or are significantly increasing in frequency.
3. There are other associated symptoms such as bruising or easy bleeding, fever, weight loss or rash.
4. Nosebleeds are consistently occurring from one nostril.
5. You should always seek care sooner if your child has an underlying medical condition.

How can I prevent nosebleeds?

In children who have frequent nosebleeds, there are some steps that you can take to help prevent them.

• Keep your child's nails clipped.
• Run the humidifier in the room with your child overnight.
• Apply nasal saline spray to the nose a few times per day. If this doesn't seem to be enough, saline gels or vaseline may also be an option but talk with your doctor.
• Seek medical care for underlying conditions, especially allergies and be consistent with your allergy regimen.

As I was writing this, I received a bunch of emails I plan to answer in a followup, but for now I'm going back to watching Stranger Things.

The 8 year old woke up in the middle of the night with a nosebleed that lasted 20 minutes. After drenching the bed and several towels, Casey, Carter’s mom, became concerned. Carter tried his best to calm his mom by saying, “I’m going to be Ok mom. It’s going to be OK.” During the nosebleed, Carter became progressively weak , seemed very pale and was complaining of vision changes like he was about to pass out.

Casey called 911, worried that something bad might happen before she could get help. Fortunately, while the first responders were on their way, the nosebleed slowed and Carter started to get back to normal but Casey still needed some reassurance that things would truly be OK.

I saw Carter soon after that night. As we talked, it became clear that, while had a history of nosebleeds, things were worsening in both how often they were occurring and how severely his nose was bleeding. We decided to keep a close eye on him and monitor when the nosebleeds were happening. Later in the week, she contacted me to let me know that his nose had bled for over an hour the previous night. During this nose bleed, he didn’t have any of the other more scary symptoms, but we both felt it was time to get him some more help.

Fortunately Natalie Roberge, M.D., one of Cook Children’s Ear Nose and Throat doctors was able to see Carter the next day. Dr. Roberge described what she discovered, “His nose bleeds were unusual because they lasted so long (up to 1-2 hours), and blood would also come out his mouth when he pinched his nose.”

The day following his appointment, Carter was scheduled for a surgery in which she “cauterized a little artery on each side of his nose to seal up the blood vessel and prevent bleeding.” He did very well with his procedure and has had no further nosebleeds since.

Nosebleeds are very common this time of year and it’s very unusual for children to require a procedure to help control nosebleeds. The blood usually comes from dry, cracked skin and fragile vessels in the nose especially in dry seasons. Even minor trauma like nose picking can cause significant bleeding.

Most nosebleeds can be controlled by applying pressure to the bridge of the nose for 5 minutes (and don’t check every 10 seconds). You can prevent nosebleeds by applying some nasal saline or Vaseline to the nose at night time, especially during dry seasons.

Dr. Roberge states that parents should “seek care for nosebleeds lasting more than 10 minutes, when the amount of blood is concerning (more than a quarter cup), more than twice a week or associated with other concerning symptoms.”