Traumatic injuries to a child’s nose can be a frightening experience for any parent or caregiver. Nasal fractures, or broken noses, are common facial injuries in children, often resulting from falls, contact sports, or motor vehicle accidents. Understanding the specific signs and appropriate steps to take provides clear guidance during this stressful time. The primary goal is to assess the severity of the injury, manage immediate symptoms, and determine whether professional medical intervention is necessary.
Recognizing the Signs of a Nasal Fracture
A child’s nose is highly flexible and more cartilaginous than an adult’s, often requiring significant force to fracture the bone, though the septum is more vulnerable. The most immediate sign of trauma is a nosebleed (epistaxis), which can be heavy but typically stops on its own shortly after the injury. Significant swelling of the nose and surrounding facial tissue usually develops quickly, sometimes obscuring whether the nose is crooked or deformed.
Tenderness and pain when the nose is lightly touched, especially at the bridge, are strong indicators of a possible fracture. You might also hear or feel a crunching or grating sensation, known as crepitus, when gently examining the nose, which suggests fractured bone ends are moving. Bruising, often appearing as “black eyes” (periorbital ecchymosis), frequently accompanies a fracture, sometimes appearing days after the initial impact.
Difficulty breathing through the nostrils is another telling sign, which can be due to swelling, internal bleeding, or a displaced nasal septum. While a clearly bent or flattened appearance suggests a fracture, not all broken noses look crooked, particularly if the break is minor or swelling is severe. The assessment of the nose’s true alignment is often best done by a specialist several days later once the initial swelling has subsided.
Immediate Care and First Aid
The first priority after a nasal injury is to manage any bleeding and minimize swelling. If the child has a nosebleed, keep them calm and seated upright, leaning slightly forward to prevent blood from dripping down the throat. Pinch the soft, fleshy part of the nose just above the nostrils firmly and continuously for 10 to 15 minutes, breathing through the mouth during this time.
To reduce swelling and pain, apply a cold compress or an ice pack wrapped in a thin cloth to the nose for 10 to 20 minutes at a time. This can be repeated every one to two hours for the first three days following the injury. Keeping the child’s head elevated, even while sleeping, by using extra pillows will help to decrease swelling.
For pain relief, appropriate over-the-counter medications such as acetaminophen or ibuprofen can be given, following the correct dosage for the child’s age and weight. Caregivers should avoid giving aspirin, as it can increase the risk of bleeding.
When Emergency Medical Attention is Necessary
Certain signs following nasal trauma indicate a potentially more serious injury than an isolated nasal fracture and require an immediate emergency room visit. Any sign of associated head trauma, such as loss of consciousness, persistent vomiting, severe headache, or changes in vision, must be treated as a medical emergency. These symptoms suggest a possible concussion or other severe head injury that takes precedence over the broken nose.
A nosebleed that cannot be stopped after 15 minutes of continuous pressure is another red flag. Clear or watery fluid persistently trickling from the nose, particularly if it is unilateral, may indicate a cerebrospinal fluid (CSF) leak, suggesting a fracture at the base of the skull. This fluid is distinct from normal mucus and requires immediate evaluation.
The most time-sensitive complication requiring emergency drainage is a septal hematoma—a collection of blood under the lining of the nasal septum. If this is not drained quickly, often within 24 hours, it can lead to destruction of the septal cartilage, resulting in a severe cosmetic deformity known as a saddle nose, and carries a risk of serious infection. Signs include a rapidly growing, fluctuating, bluish or purplish lump inside the nostril, often causing a complete blockage of one or both sides of the nasal passage.
Medical Diagnosis and Treatment Overview
Once the child is under medical care, diagnosis is primarily based on a thorough clinical examination, including palpation and an internal inspection of the nasal cavity. Physicians look for tenderness, mobility, crepitus, and assess the septum for any deviation or hematoma. Imaging, such as plain X-rays, is often avoided for an isolated nasal injury because it has low sensitivity and does not typically change the management plan, as the diagnosis is clinical.
A computed tomography (CT) scan is usually reserved for cases where suspicion of other facial or skull fractures is present due to high-energy trauma, or when complex injuries require detailed surgical planning. Initial treatment focuses on pain management, controlling swelling, and ensuring that serious complications like a septal hematoma are addressed. If a septal hematoma is found, it must be incised and drained urgently to prevent long-term damage.
For simple fractures where the nose is crooked or breathing is affected, the definitive procedure to realign the bones, called a closed reduction, is frequently delayed. This delay allows significant swelling to resolve, which typically takes between three and ten days after the injury. The reduction must ideally be performed within two weeks, before the bones begin to set in the incorrect position. The procedure usually involves manually manipulating the bones back into place under local or general anesthesia, followed by the application of an external splint.