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  • Nose Injury

    Definition

    • Injuries to the inside or outside of the nose

    Types of Nose Injuries

    • Bloody nose without a fracture
    • Swelling and bruising of the nose without a fracture
    • Blood clot of the central wall of the nose. Risk of cartilage damage and deformed nose.
    • Fracture of the nose. Severe fractures of the nose (crooked nose) are usually reset the same day. This requires surgery in the operating room. Most surgeons don’t repair mild fractures until 5 to 7 days after the injury. Caution: A nasal fracture must be re-set before 10 days.

    When to Call Us for Nose Injury

    Call 911 Now (your child may need an ambulance) If:

    • Major bleeding that can’t be stopped
    • Passed out (fainted) or too weak to stand
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • You think your child has a serious injury
    • Nosebleed that won’t stop after 10 minutes of squeezing the nose correctly
    • Pointed object put in the nose and caused pain or bleeding
    • Skin is split open or gaping and may need stitches
    • Pain is SEVERE and not improved 2 hours after taking pain medicine
    • Deformed or crooked nose (not just swelling)
    • Foreign body in the nose and can’t get out
    • Breathing through the nose is completely blocked
    • Age under 1 year old
    • Nose becomes infected (fever, a yellow discharge, redness)
    • You think your child needs to be seen urgently

    Call Us Within 24 Hours (between 9 am and 4 pm) If:

    • You think your child needs to be seen, but not urgently
    • Shape of the nose has not come back to normal after 4 days

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • No tetanus shot in over 5 years for DIRTY cuts
    • No tetanus shot in over 10 years for CLEAN cuts

    Parent Care at Home If:

    • Minor nose injury

    Care Advice for Minor Nose Injury

    Nosebleed:

    • To stop a nosebleed, squeeze the soft parts of the nose against the center wall.
    • Do this for 10 minutes to put pressure on the bleeding point.
    • Use the thumb and index finger in a pinching manner.
    • If the bleeding continues, move your point of pressure.
    • Have your child sit up and breathe through the mouth during this procedure.

    Skin Bleeding:

    • For any skin bleeding, put direct pressure on the wound.
    • Use a gauze pad or clean cloth.
    • Press for 10 minutes or until the bleeding has stopped.

    Cleansing:

    • After the bleeding has stopped, wash the area. Clean with soap and water for 5 minutes.
    • If a large area, use an antibiotic ointment such as Polysporin. No prescription is needed.
    • Then, cover with a Band-Aid for 1 day.

    Cold Pack:

    • For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
    • Put it on the nose for 20 minutes.
    • Repeat in 1 hour, then as needed. Caution: Avoid frostbite.

    Pain Medicine:

    • To help with the pain, give acetaminophen (such as Tylenol) or ibuprofen. Use as needed. See Dose Table.

    Concerns About Missing a Minor Nasal Fracture:

    • If a swollen nose is the only finding, usually it’s not broken.
    • Even if it’s broken, standard practice is to delay correction for a few days. This allows the swelling to go away. Reason: The swelling interferes with seeing the shape of the nose.
    • X-rays are often not helpful. Reason: Most of the nose is cartilage. Injuries to the cartilage do not show up on X-ray.
    • Looking at the nose after the swelling is gone is preferred. You can usually do this by day 4 or 5. This is the best way to tell if it is fractured. It will look different than it used to. Delayed correction also helps the surgeon better see what needs to be corrected.
    • Caution: If the nose is broken, an ENT surgeon must re-set it. This should be done BEFORE the 10th day.

    What to Expect:

    • Nose pain and swelling usually peak on day 2.
    • They go away over 3 or 4 days.

    Call Your Doctor If:

    • Pain becomes severe
    • Nasal passage becomes blocked
    • Shape of the nose has not come back to normal after 4 days
    • Signs of infection occur (a yellow discharge, more tender to touch or fever)
    • Your child becomes worse

    Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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