Nosebleeds at School: Positioning, Comfort, and Escalation Criteria

1) Positioning: seated, leaning forward (and why)

A nosebleed (epistaxis) is usually from small blood vessels near the front of the nose. The goal at school is to stop the bleeding while keeping the student calm and preventing blood from flowing into the throat.

• Seat the student upright (on a chair, bench, or the floor with back supported). Upright posture reduces blood pressure in the nasal vessels compared with lying down.
• Lean the student slightly forward with the chin angled toward the chest (not tucked tightly). This helps blood drain out through the nostrils rather than down the throat, which can cause coughing, gagging, nausea, or vomiting.
• Encourage slow breathing through the mouth. Offer a tissue or disposable towel to catch blood from the nostrils.
• Comfort and privacy: move away from an audience if possible, speak calmly, and explain what you are doing (“We’re going to pinch the soft part of your nose for 10 minutes.”). Anxiety can increase heart rate and worsen bleeding.

Quick positioning checklist

• Upright seated
• Lean forward
• Mouth breathing
• Blood allowed to drip out (into tissue/basin)

2) Pinch technique: where to pinch and how long

Consistent technique matters more than frequent checking. The most common mistake is pinching too high on the bony bridge or releasing too soon.

Step-by-step protocol

1. Put on gloves if available (blood exposure). If gloves are not immediately accessible, prioritize stopping the bleed and avoid direct contact when possible (use a barrier like gauze/tissue).
2. Locate the soft part of the nose: pinch the nostrils together just below the bony bridge (the compressible, fleshy area).
3. Pinch firmly and continuously using thumb and index finger. Pressure should be steady, not pulsing.
4. Time it: maintain pressure for 10 full minutes without releasing to “check.” Use a clock/timer.
5. After 10 minutes, release gently and look for continued bleeding.
6. If still bleeding, repeat once: pinch again for another 10 minutes.

Helpful additions (optional)

• Cold compress on the bridge of the nose or cheeks may help comfort; it should not replace pinching.
• Student self-care: if age-appropriate, have the student pinch their own nose while you supervise (reduces discomfort and preserves dignity).

3) What to avoid (common mistakes)

• Do not tilt the head back. This sends blood into the throat, increasing swallowing and the risk of nausea/vomiting; it also hides ongoing bleeding.
• Do not pack tissues/cotton deep into the nostril. Deep stuffing can irritate the lining, dislodge clots when removed, and may leave material behind.
• Do not have the student lie down unless there is another urgent reason; lying flat promotes blood flow toward the throat.
• Do not repeatedly release pressure to check. Early checking breaks clot formation and prolongs bleeding.
• Avoid vigorous talking, laughing, or physical activity during active bleeding; it can increase bleeding.

4) Aftercare and restrictions (once bleeding stops)

Once bleeding has stopped, the priority is to protect the new clot and reduce re-bleeding during the school day.

Immediate aftercare steps

• Keep the student seated and calm for 5–10 minutes after bleeding stops.
• Clean-up: have the student gently wipe around the nostrils; avoid rubbing inside the nose.
• Check for continued oozing. A small smear on tissue can be normal; steady dripping is not.

Restrictions for the next few hours (school-appropriate guidance)

• No nose blowing (at least a few hours; longer if the student has re-bled before).
• No nose picking and avoid rubbing the nose.
• Avoid strenuous activity (running, sports, rough play) for the remainder of the period/recess; consider a brief rest in a supervised area.
• Sneeze with mouth open if needed to reduce pressure in the nasal passages.
• Hydration is fine; if the student swallowed blood and feels nauseated, allow a quiet rest and monitor.

5) Red flags and escalation criteria

Most school nosebleeds stop with correct pressure and time. Escalate when bleeding is prolonged, heavy, recurrent, or linked to injury or systemic symptoms.

Escalate to school nurse/office and contact parent/guardian promptly if:

• Bleeding continues after 20 minutes of correct pinching (two full 10-minute cycles).
• Heavy bleeding (rapid dripping/flow, soaking multiple tissues quickly) or the student is spitting out large amounts of blood.
• Repeated episodes in the same day or frequent episodes over days/weeks (needs follow-up planning).
• Known bleeding disorder or the student is on medication that affects clotting (if this is known in school records).
• Suspected foreign body (especially unilateral bleeding with foul odor or persistent irritation) or the student reports putting something in the nose.

Urgent escalation / call emergency services according to school policy if:

• Signs of shock or significant blood loss: pale/clammy skin, dizziness, fainting, confusion, weakness, rapid breathing, or the student cannot remain upright.
• Breathing difficulty or choking/coughing on blood that cannot be managed with forward positioning.
• Injury-related nosebleed with concerning features: significant facial impact, suspected nasal fracture, deformity, severe pain, or persistent bleeding after trauma.
• Bleeding that restarts repeatedly despite correct technique and rest, especially with worsening symptoms.

Practical “when to stop trying at school” rule

If you have done firm pressure on the soft part of the nose for 10 minutes, then repeated for another 10 minutes, and bleeding is still active, treat it as not controlled and escalate.

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6) Communication and documentation template (especially for recurrent cases)

Consistent communication reduces anxiety for students and families and helps identify patterns (dry air, allergies, habitual picking, sports impacts). Use neutral, factual language.

What to tell the student (script)

• “Nosebleeds are common. You’re safe.”
• “Lean forward and pinch the soft part of your nose. I’ll time 10 minutes.”
• “Try not to talk or sniff. Breathe through your mouth.”
• After stopping: “No blowing or picking for a while so the clot can stay in place.”

What to tell the parent/guardian (key points)

• When it started and how long it lasted
• What was done (positioning, pressure duration, number of cycles)
• Whether there was injury, recurrence, heavy bleeding, or symptoms like dizziness
• Any restrictions given (no blowing, rest from activity)
• Recommendation for medical follow-up if recurrent/prolonged

Documentation template (copy/paste)

Student: ____________________  Grade/Class: __________  Date: __________  Time: __________  Location: __________

Observed nosebleed (epistaxis):  Left / Right / Both (circle)
Suspected trigger:  spontaneous / dry air / nose picking / sneeze/cough / sports / impact to face / unknown

Positioning used:  seated upright + leaning forward (Y/N)
Pinch location:  soft part below bony bridge (Y/N)
Pressure timing:  10 minutes continuous (Y/N)  Second 10-minute cycle (Y/N)
Cold compress used for comfort (optional):  Y/N

Outcome:
- Stopped after first 10 minutes (Y/N)
- Stopped after second 10 minutes (Y/N)
- Continued bleeding after 20 minutes (Y/N)  -> Escalated to: nurse/office/EMS per policy

Symptoms noted:
- Dizziness/faintness (Y/N)  Pale/clammy (Y/N)  Nausea/vomiting (Y/N)  Breathing difficulty (Y/N)

Injury involved:  none / minor bump / significant facial impact / suspected nasal injury (circle)

Aftercare instructions given:
- No nose blowing (Y/N)  No picking/rubbing (Y/N)  Rest from activity (Y/N)  Sneeze with mouth open (Y/N)

Parent/guardian contacted:  Y/N  Time: ________  Method: phone/email/text/other
Summary of message: ________________________________________________________________

Recurrent pattern noted (if applicable): ______________________________________________
Follow-up recommended:  monitor / nurse check-in / parent to seek medical advice

Staff name/signature: ____________________________  Witness (if any): __________________

Recurrent-case planning (school-based)

• Flag patterns: same time of day, after recess, during allergy season, in heated/dry rooms.
• Agree on a consistent response plan with the nurse/office: where the student goes, who times the 10 minutes, and when parents are called.
• Student self-management (age-appropriate): teach the student to recognize early bleeding and start the forward-lean + pinch routine promptly with supervision.