The Airway

Air enters our body through the nose. The air passes through the nasal passages. On both sides of the nose are structures called turbinates which humidify and warms the air. The nose is divided into 2 halves by the septum. On the septum there is an area called the Little’s Area which is prone to bleeding. This is often seen in children.

The air proceeds down the back end of the nose called the postnasal space. The adenoids are situated in this location. From there it enters the back of the mouth known as the oro-pharynx. The tonsils sit on two sides of the oropharynx.

Further down the throat the air passes between the vocal cords in the larynx and enters the the windpipe also called the trachea into the lungs.

Nose Bleeds

Nose Bleed in children is of very common problems. They then to occur between the ages of  2 to 10. Nose bleeds in infants is unusual and should be evaluated by an otolaryngologist (ENT Doctor). Most nose bleeds occur in children occur infrequently, some children can have recurrent nose bleed. While often the nose bleeds are not serious, it can causes significant anxiety to both the parent, child and teachers. Most nose bleeds do not have an easily identifiable cause. The known causes of nose bleed in children are listed below.

The air proceeds down the back end of the nose called the postnasal space. The adenoids are situated in this location. From there it enters the back of the mouth known as the oro-pharynx. The tonsils sit on two sides of the oropharynx.

Further down the throat the air passes between the vocal cords in the larynx and enters the the windpipe also called the trachea into the lungs.

Causes of Nose Bleed in Children

Trauma : A blow or a knock to the nose from the outside can cause a nose bleed. Nose picking which is trauma from inside can also cause nose bleed.
Prolonged exposure to dry air especially in cold climates ca result in nose bleeds

Allergic Rhinitis or Sensitive Nose or more commonly referred to as ‘Sinus’. This cause the lining to be fragile and easily traumatized resulting in nose bleeds
Nasal & Sinus Infection causes inflammation of the lining of the nose which predispose it to nose bleeds

Foreign Body in the Nose. Children especially the younger ones have a habit of putting objects such as peas, tissue paper and beads in the nose. This cause trauma as well as infection which result in nose bleeds.

Vigorous Nose Blowing. The shearing effect causes the wall of the fragile blood vessels to break resulting in nose bleed

Deviated Nasal Septum. The narrowed nasal passage causes turbulence in the airflow which dries up local area in the nose resulting in it being more prone to nose bleed.

After Nose / Nasal Surgery. Nose bleed can result from the trauma of the procedure.

What to do when Children have a Nose Bleed

Remain Calm
– Sit the child in upright position and pinch the soft portion of the nose with the thumb and index finger for 10 minutes (time this with a clock)
– Do not swallow the blood. Instead spit the blood in the mouth into a bowl. Blood in the stomach makes the individual sick and may make him vomit
– Do not strain, carry heavy things or blow the nose (sniffing is all right)
– Ice packs on the cheeks or forehead may be helpful.
– This should stop most of the nose bleed in children.
– If the nose bleed in children is frequent or in large amount, bring the child to see and ENT doctor.

What to do after the Child’s Nose Bleed has stopped

– Avoid blowing the nose forcefully, sneezing or coughing
– Nasal Saline Spray or lubricating gel may be helpful in promoting healing

When to bring a Child with Nose Bleed to an ENT Doctor?

– If the child has frequent nose bleeds
– If the child has a large amount of bleeding
– If there are symptoms of other Nose problem such as allergic rhinitis and  sinus infection

What to expect at the ENT doctor?

The ENT Doctor will examine the child. He may also do a nasal scope to determine the source of the bleeding.
If the blood vessels are visible and the child co-operative, the ENT doctor can cauterize the blood vessels with a chemical called silver nitrate or with electrical current.

Blocked Nose & Snoring – Causes

Nasal Obstruction or Blockage of the nose can occur at any age. They are due to many reasons. When the there is obstruction of the upper airway, snoring or noisy breathing takes place.

Long term mouth breathing and snoring has been linked to poor sleep quality. If severe, the child may have obstructive sleep apnoea. The child stops breathing or holds his breath many times through the night. The child wakes up lethargic, unable to focus on his activities or school. Their academic performance is often affected. Mouth breathing can lead to upper mouth teeth crowding requiring dental correction later.

Newborn are obligate nose breathers that is if there is any blockage of the nose, they will have significant problems with breathing. The causes of nasal obstruction (blocked nose) at this age are choanal atresia (where there nose passage is not patent) and enlargement of the normal structures in the nose such as the turbinates. Excessive mucus production can also contribute to block nose.

In the older children, blocked nose can be due to narrowing of the nasal passages by

Turbinate enlargement: this can be caused by allergy, sinus infection (sinusitis) or a flu. If the obstruction is persistent despite medication, turbinate reduction using coblation or radio frequency is a simple procedure that can effectively enlarge the nasal passage.

Deviation of the nasal septum: the nasal septum is the internal centre divide of the nose. Trauma from childbirth or a knock on the nose can cause it to buckle to one side and narrow the nasal passage causing a blocked nose (nasal obstruction).

Adenoids Hypertrophy: the adenoids can grow to a large size and blocked the back end of the nasal passage. The child is often mouth breathing, a nosily breather or snores during sleep. Removal of the adenoids is often the only way to cure the obstruction if there are no other reversal factors.

Tonsil enlargement: This often goes hand in hand with adenoid enlargement. The tonsils besides causing breathing problem, can also cause the child to be a slow eater or poor eater. Snoring can be prominent. If the tonsilar enlargement is persistent, then removal of the tonsil will eliminate the problem.
Treatment of nasal obstruction in children requires accurate diagnosis. The ENT doctor  will be able to co-ordinate treatment of the allergies, upper airway infections such as sinusitis as well as deal with structural obstruction to the air passages.

Cold or Sinusitis

Sinusitis is often difficult to diagnose in children because respiratory infections are more frequent, and symptoms can be subtle. Sinusitis need to be evaluated by a physician to prevent long term complications.

The following symptoms may indicate a sinus infection in your child:
– a “cold” lasting more than 10 to 14 days
– low-grade fever
– thick yellow-green nasal nasal discharge
– post-nasal drip with chesty (wet) cough, throat clearing, vomiting
– irritability or fatigue
– headache
– swelling around the eye

Foreign Bodies In the Nose

Children are curious individuals. They explore the environment around them, put their hands on all manners of objects with in their reach. Often, especially the young ones like to put small objects into their mouth, ear and nose. There may not be any clear indication that this has happened.

Some signs that suggests that there may be something in the nose is a unilateral (one sided) nasal discharged, especially if this is yellow or green in nature and or nose bleeds. There may also be pain when infection occurs. If you suspect that there may be a foreign body in the nose, DO NOT ATTEMPT to remove it as it may push it further in and risk being aspirated. Instead bring the child to an ENT doctor who will be able to assess and remove the foreign body. In certain situation, if this is not accomplished in the clinic, one may have to do it under general anaesthesia.

Pang Xin Yi
Pang Xin Yi
15 April 2024
I consult Dr Pang for various issues - from nose bleed to chronic hives to ear block. He is always very thorough in his work. Dr Pang is very easy to talk to, and always tries to understand not just your condition, but your medical history and the environment you live and work in. He asked thorough questions about my medical and lifestyle history, carried out allergen tests to narrow down possible causes and gave very detailed advice on how to manage my hives condition. Appointment times are also adhered to (give and take 10-15min allowance which I find totally acceptable). Dr Pang also shares treatment options openly but always left it to my own discretion to pick the one I am most comfortable with. I also appreciate his staff for always being friendly and patient, and giving clear instructions when I had tests to take. It’s hard to find a clinic these days where you could have a comfortable and relaxed visit so I am glad that I found them.
Vijesh Kishore
Vijesh Kishore
15 April 2024
Dr. Pang Yoke Teen with his pleasing personality and quick diagnosis and great advise thinking always the best for the patient . One of the few doctors who believe in giving less medicines the minimal required and the clinic staff is very helpful, efficient and caring and accommodative
Oriana De Saint Priest
Oriana De Saint Priest
1 April 2024
I had a very good experience with Dr Pang YT and can highly recommend him for his professionalism
Poh Wee Koon
Poh Wee Koon
22 March 2024
Been visiting Dr Pang for allergy-related issues for a year and counting. The service is always prompt and friendly, and treatment as well as symptom management has been great. Appointments are not too hard to get, and picking up of medication is easy too. All good and a nice, friendly place to seek help at.
Stefan Andersson
Stefan Andersson
22 March 2024
I’ve had a very good experience at Dr Pang’s clinic. I had concerns around sleep apnea and Dr Pang identified that I was suffering from a lot of different allergies and food sensitivities. Now I’m getting treated for some of these allergies and it has improved my life quality a lot which I’m so grateful for. Him and his team of nurses are also super friendly and down to earth so it’s always a nice experience visiting the clinic as well! Highly recommended.
Elizabeth Lee
Elizabeth Lee
21 March 2024
First visit to Dr Pang was almost 10 years ago where he treated my extremely severe allergic rhinitis. My allergies were so bad that I would get attacks triggered every single day in normal environments. Ever since the treatment I have probably only experienced allergy attacks less than 5 times in the past 10 years, and those times I can pinpoint were in dusty conditions. Thank you Dr Pang for changing my life for the better!! Will always be grateful to you and your clinic :)
Aditi Mann
Aditi Mann
19 March 2024
Thank you Dr Pang Yoke Teen for helping me to cope with my allergies! I went to Dr Pang after suffering from severe allergies for several years. My nose congestion and eye irritation would completely ruin my quality of life. At the first consultation Dr Pang was able to diagnose the problem and prescribed the necessary medication. I started to feel better after taking the medication for just a couple of days. I have been under Dr Pang’s care for more than 6 months now and I have almost forgotten what it is to have an allergy! A special mention for Sheila and the other staff who also make the experience to the clinic an easy and comfortable one - thank you too!
Shao Wei Tan
Shao Wei Tan
13 March 2024
I’ve had a sensitive nose and sinus issues since childhood. After consulting Dr Pang, I went for a surgery and on a course of immunotherapy. It just works — I almost never get runny / blocked nose anymore unless I’m actually sick!
Derrick Tan
Derrick Tan
6 March 2024
Had issues with allergies for a really long time and Dr Pang came up with an effective treatment plan which includes immunotherapy. Feeling better now

Centre For Ear Nose Throat Allergy & Snoring

3 Mt Elizabeth
#16-11 Mt Elizabeth Medical Centre
Singapore 228510

Tel: +65 65860988
What’sApp: 6598277186