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.

Christina Ho
Christina Ho
2024-06-16
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I've been seeing Dr Pang since Dec'23 for loud ringing noises in one of my ears. Unlike most other specialist clinics, I didn't have to wait long to be seen for each appointment. Whenever specific medical tests were required, all tests were arranged by the clinic, reducing much anxiety and stress. Tests were carried out punctually and efficiently, within the clinic, doing away with the hassle of searching around the hospital for the location of the testing departments. After the tests, the reports were all sent to me via Whatsapp, which made things really convenient. Dr Pang has listened patiently to all the symptoms and problems I've mentioned regarding the ear issues. With the treatment advised, I've found that the prescribed medication has not only helped me cope better with the ringing noises, but I've gradually experienced improvements in my overall physical well-being.
Manuel Hall
Manuel Hall
2024-06-11
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My sinus problems were solved in 1 week, the way the doctor managed the symptoms and the treatment was very effective.
jing wang
jing wang
2024-06-10
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This time, I accompanied my child to check her nasal cavity. Dr. Pang was gentle, patient and meticulous in reducing the child's fear.
Raymond Lee
Raymond Lee
2024-06-04
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Dr Pang is a very professional specialist in ENT, I visited him twice, last year is about my ear tinnitus, did and MRI and everything is good, this time is for my nose. Dr Pang is patience to explain everything to me. I will definitely recommend Dr pang to anyone who need.
Raeanne Ang
Raeanne Ang
2024-05-21
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Thanks to Dr Pang I have been able to get rid of nasal congestion and deal with allergies that have been affecting my quality of life for many years
Phil L
Phil L
2024-05-07
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Doctor Pang was approachable and knowledgeable. He very quickly understood and explained my problems and recommended a holistic treatment plan. I have experienced amazing results thus far just one month into treatment.
Toh Kai Sheng Edwin
Toh Kai Sheng Edwin
2024-05-02
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Was suffering from bad vertigo and constant dizziness. Visited Dr Pang and the condition has improved significantly.
aki menyanan
aki menyanan
2024-04-30
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I recomend the doctor to people with allergies. He is very patient and friendly when talking. He succesfully helped my daughter with her allergies. 👍🏼👍🏼👍🏼
Michiko. H
Michiko. H
2024-04-30
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I've had very bad allergies to dust mites and often getting runny nose and sneezing. Dr. Pang gave us the correct medication that has helped me cure my allergies. Not only that, he is also very friendly while talking and is very intelligent when giving us medication.


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