Two minor-looking sideline injuries that get handled wrong constantly. Both have published protocols. Both matter more than parents realize when handled poorly.
Nosebleeds: the pinch-and-lean technique.
Most nosebleeds come from the front of the nose (anterior epistaxis), where small blood vessels in the septum are easy to bump. The protocol:
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Sit the kid up. Lean forward, not back. The “tilt your head back” technique is a myth and is worse than doing nothing. Tilting back sends blood down the throat, causes choking, and prevents you from seeing whether the bleed is slowing.
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Pinch the soft part of the nose between thumb and index finger. The soft part is the lower third, below the bony bridge. Squeeze firmly.
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Hold continuous pressure for 10 minutes. Do not peek. Each peek restarts the clock. This is the part most people fail.
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After 10 minutes, release slowly. If bleeding has stopped, the kid sits quietly for another 10 to 15 minutes before any activity. No nose-blowing, no rubbing, no lifting.
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If still bleeding after 10 minutes of pressure, repeat for another 10 minutes.
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If still bleeding after 20 minutes total, seek medical care.
What does not work: tissue stuffed up the nose without external pressure, head tilted back, ice on the back of the neck, sitting down without leaning forward.
A tampon used as a packing material works for severe nosebleeds when nothing else is on hand. Wrap in clean gauze if available, insert into the bleeding nostril, then continue external pressure.
When a nosebleed is more than a nosebleed.
If the kid took a hit to the face and the nose is visibly deformed, or if there’s significant facial pain, or if the bleed is heavy and not slowing, possible nasal fracture. Get to urgent care or ER. Suspected facial fracture also warrants a check for septal hematoma (a blood pool in the septum), which needs prompt drainage to prevent septum collapse.
If the kid has a known bleeding disorder, is on blood thinners, or is bleeding from both nostrils repeatedly, seek medical care faster than the 20-minute rule.
Bleeding from one nostril after a fall on the head, especially clear fluid mixed with blood, can be a sign of skull fracture with cerebrospinal fluid leak. Rare. ER.
Eye injuries: the triage.
Most eye injuries on the field are minor: dust, sweat, contact lens displacement, scratched corneas from a finger or stick. The ones that matter look different and need fast escalation.
Get to the ER, now.
Visible foreign object embedded in the eye. Do not remove it. Cover with a paper cup or rigid shield (not pressure), and transport.
Penetrating injury or visible cut on the globe. Same protocol. No pressure. Shield only.
Sudden vision loss, double vision, or “curtain” across vision. Possible retinal detachment, vitreous hemorrhage, or hyphema (blood in the front chamber of the eye). ER.
Pupil that won’t react to light, or pupils unequal in size after impact. Possible head injury or eye injury affecting the optic nerve. ER.
Ruptured globe (the eye looks deflated or has visible fluid leak). ER, no pressure on the eye.
Chemical splash. Flush with clean water for 15 to 20 minutes continuously, then ER.
Manage on the sideline.
Foreign body sensation (felt like something flew in) but no visible object: blink several times, flush with sterile saline if available. If the sensation persists after 30 minutes, urgent care.
Black eye (periorbital hematoma) without vision change: cold pack (wrapped, not directly on the eye), monitor for vision change, no immediate ER unless other symptoms.
Subconjunctival hemorrhage (red blood patch on the white of the eye). Looks alarming. Usually from sneezing, coughing, or minor trauma. Resolves in 7 to 14 days. Pediatrician or ophthalmologist follow-up if there was significant impact.
Scratched cornea (corneal abrasion). The kid says it feels like sand. Pain, light sensitivity, tearing. Pediatrician or ophthalmologist same day. Most heal in 24 to 72 hours with antibiotic drops.
What not to do.
Do not rub the eye. Rubbing makes corneal abrasions worse and can dislodge embedded foreign bodies into deeper tissue.
Do not apply pressure to a possibly ruptured or penetrated eye.
Do not try to remove an embedded foreign body.
Do not flush a possibly penetrated eye with water (could push contaminants deeper).
Eye protection prevents most of this.
Polycarbonate impact-resistant lenses for kids who wear glasses. The American Academy of Ophthalmology recommends sport-specific eyewear for racquet sports, lacrosse (girls), basketball, baseball/softball, and field hockey. ASTM-F803 is the certification for sport eyewear.
For girls’ lacrosse, ASTM-F3137-certified goggles are required. For boys’ lacrosse, the helmet covers most eye-injury mechanisms.
The honest read. Most nosebleeds and minor eye injuries handle on the sideline. The ones that turn into long-term problems are nearly always the ones where the wrong technique was used (tilted head back, rubbed the eye, removed the embedded object). The 20-minute nosebleed rule and the “shield, don’t press” eye protocol cover the vast majority of cases. Anything outside that, escalate.