18 month old broken nose - help!

[Tiredofallthis101]

Hi all,

My 18 month old DC fell off a chair on Christmas Day and we suspect has a broken nose (though appreciate little ones don't have much bone in their noses so likely not a proper break). Sought advise from emergency care doctor friend who said he should be fine, monitor him closely, and hopefully swelling and pain should subside over 3-4 days. Little one has significant bruising on his nose and the end of it is also very red. Bled quite a bit on the day and lots of old blood the following day combined with lots of snot. He hasn't seemed bothered by it (cried for a minute when it happened and then doesn't seem to have been in pain since).

However today it seems to be bothering him and any gentle touching of it (eg carefully putting clothes on him) makes him cry. Swelling still significant and he keeps crying in his sleep (last night and tonight)? Planning to take him to the GP tomorrow but just wanted to check: 1) I don't need to take him more urgently and 2) whether there is anything I can do to help him in the meantime.

I've given him nurofen and he's currently fast asleep so hopefully fine but I'm worried about my poor boy, so hard seeing him suffering.

Don't have advice.. poor wee thing hope all is well soon with him 🙏

Poor thing, pop into your local walk in centre/ urgent care centre. They should refer you to ENT and they will see you in 10-14 days once swelling has subsided. Good luck!

I would be phoning for medical advice and to try to get painkillers as soon as possible.

Hopefully nuforen will help with the swelling. Will he tolerate an ice pack on it?

Poor thing 😢

I don’t think a gp will be able to do much apart from refer you tbh. Do you have a minor injuries unit near you? I would want to take my baby there to get checked out properly.

My husband broke his nose some years ago. It will be painful. The issue is will be what type of break it is. An aligned break will heal on it's own, a non aligned break will require surgery. If it is aligned they will probably prescribe something for pain and swelling and leave it to heal. If it's a non-aligned break they will possibly have to do what they did with my husband: prescribe pain and swelling relief for a week or so, then take him into theatre, re-break his nose, align it properly and tape it until healed.

It terms of where you take him, I'm 99% sure they will need to x-ray so GP won't be able to treat him. Check whether the minor injuries unit has an x-ray and will treat children. If so, that sounds like a good call. If not, nearest A+E that takes children. I would think there is no point taking him somewhere without an x-ray - they will refer you on.

I am shocked you haven’t taken him to minor injuries/a&e already. It’s 3 days later for heaven’s sake- and a bump hard enough to break his nose is hard enough to cause concussion. 18 months is tiny, he can’t even explain where it hurts and what his symptoms are. Get the child to minor injuries asap.

Thanks all for the advice/ well wishes.

@JollyGreenSleeves my local A&E is in dire straits and really push back on anyone going for anything that isn't basically imminent death. having taken him previously for something similar (his sister pushed him over on concrete and he injured his nose badly) last time they told me little ones are unlikely to do any major damage to themselves if they have just hit their nose. They told me no need to bring him in if similar happened again. I followed up with an A&E doctor friend who said don't take him if he shows no signs of concussion/any other worrying symptoms, which he hasn't. His nose is aligned, he's been happy and his normal self - until a few hours ago when he started fussing.

@Tractortedd unfortunately local minor injuries won't see under 2s and the A&E as above previously told us not to go unless there were worrying symptoms (loss of consciousness, personality changes, seizures, significant continued crying etc). But I do think when I call the GP tomorrow they may well tell us to go anyway. Which of course I will, just don't want to waste anyone's time including that of a sad poorly little boy.

@Cherrypickled no unfortunately he won't tolerate an ice pack at all, we've tried that a couple of times. Gah.

I can’t imagine a doctor telling you not to bring him again in the manner you’ve described. He is a baby, they would always rather be safe than sorry with a baby. You’ve said it bled a lot. That it’s swollen and bruised and that he was crying last night and tonight and won’t let you touch it. That doesn’t describe a minor bump- he is still distressed 4 days later and you’re having to give him pain relief. You sound far too relaxed.

C'mon OP this is your child not a sack of potatoes! Take them to another A+E then if the nearest is shit, and get them checked. It's a bloody head injury in an under 2! I'd drive as far as it took to get my DC seen (and have twice in the past when nearest A+E was shit).

My youngest slid into a metal bed frame abroad, full frontal impact on the nose after sliding in the tiled bedroom floor.
We were convinced he’d broken his nose and got the local doctor to come out.
he said he couldn’t break his nose as the bone was too flexible still (he was a similar age to yours, around 2.5 at the time).
He did get 2 black eyes, had a bloody nose and was very subdued and we were ordered to keep him as quiet as possible.
We flew home 2 days after.
It healed fine he is now 16 with no issues.
i think id see a doctor regardless. But just letting you know our experience was that nose breaks are rare in young kids. HTH

Agree. They’ll probably make a safeguarding note - especially as something similar has happened before, but that is normal and the right thing to do. They can do an assessment (even if that means to do away and come back). Most importantly, they can prescribe painkillers much stronger than you are able to give him over the counter.

Have you called 111? Give them a ring and see what they have to say, if they recommend A&E i think they will give them a heads up you are coming in so you won’t face an interrogation as it’s technically a referral.

Edit: I have a child of similar age and would have taken them to A&E straight away on the day. Granted I don’t have a doctor friend as you do, but with kids I would err on the side of caution as things can nosedive quickly.

I agree with this. What one doctor at A&E said once is not the same as what all doctors will say.

I had a friend whose similar aged child burnt their finger on a radiator pipe, it was quite bad but they ran it under water etc. A few days later they took him to the pharmacy who said it would probably require the hospital checking it out as it covered the underside of the knuckle and needed to heel properly/not too tight or he'd lose mobility in that digit. The doctor at the hospital reported my friend to social services (nothing came of it) as a child under 2 years of age had an accident that needed medical attention but said my friend had delayed medical care. Although she'd gone to the pharmacist that isn't recorded anywhere like A&E or the GP. It wouldn't surprise me if similar happened here, it's been days and you have a young child with a potential broken nose, blood, it hurts, with swelling and you're still just contemplating the GP. He'll need an x-ray as a minimum, get yourself to A&E, the wee lad is in pain.

absolutely take dc to A&E it’s not the kind of thing you wait on OP. They will not turn away a toddler in this condition and you need to make sure that the area is Xrayed to know what kind of break it is. Different breaks require different intervention and they need to assess for any additional injuries or internal bleeding due to the area injured.

I understand it can be hard to know what the right thing to do is when it’s your own DC and emotions come into it but absolutely get DC to the hospital.

hope dc feels better soon OP

I can't believe you've left it 3 days.

You suspect a broken nose and yet haven't taken him in anywhere? What am I reading??

not like me to say go to A&E but on this occasion I would for sure. The best time to do it would have been when it happened, second best time is now.

Thanks all for the advice. Little one slept well last night and has woken up this morning happy, with a new canine popped through. He isn't bothered at all about his nose being touched so I wonder if it wasn't his nose bothering him at all yesterday but the tooth cutting through. Swelling now pretty much gone too which is good. Still planning to call for further medical advice again today and get him seen just in case.

To those suggesting it was irresponsible to not take him to A&E - I got him assessed by my friend who is an A&E doctor. She told me as above not to take him because in one so little they were unlikely to break their nose so the hospital wouldn't do an x ray unless it looked visibly misaligned. They also don't prescribe strong painkillers for little ones again unless there's a reason to do so - and again for the three days afterwards he showed no pain or worrying symptoms. Also the suggestion of going to an alternative A&E our nearest A&E is already 25 miles and an hour's drive away, the next closest is more like an hour and a half. Which I'd happily do if I thought it would benefit him eg if he wasn't getting the treatment I thought he should be getting. But in this case I've been advised by two doctors there is nothing they could/would do in this case and to keep monitoring him. So I disagree that I've done the wrong thing. Making the poor thing sit for 90 mins in the car to get to another poor quality A&E when they likely wouldn't do anything doesn't seem sensible.

Glad he's feeling better. Though not sure why you posted your questions on here if you'd spoken to (two now) doctors and were happy with their advice and your subsequent decision. All the best and hope he continues to improve.

I posted because I wasn't sure. Last night my son seemed to be suffering because of his nose so I was worried that the advice I had had from the doctors was wrong. I'm only happy with the decision now I know he's OK- obviously if he had been suffering with a significant injury I would have been devastated that I didn't take him earlier. But luckily the advice was right which is good.