Seeing milk exit a baby’s nose can be alarming, but this common event, known as nasal regurgitation, is typically a normal part of infant development. Up to 67% of healthy infants experience some form of regurgitation in their first three months. Understanding the mechanics behind this occurrence can help parents remain calm and focus on management. This phenomenon is usually not indicative of a serious health problem as long as the baby is otherwise healthy and thriving.
Why Milk Comes Out the Nose
Nasal regurgitation occurs due to the still-developing anatomy of an infant’s upper digestive system. A baby’s throat and nasal passages are closely connected, allowing milk brought back up to easily divert into the nasal cavity instead of exiting through the mouth.
The primary physiological factor is the immaturity of the lower esophageal sphincter (LES). This ring-like muscle acts as a valve between the esophagus and the stomach, and its weakness in newborns allows stomach contents to flow back up easily (reflux or spit-up). Common triggers that increase pressure on the LES include swallowing air during feeding, which creates gas bubbles that push milk upward, or having a stomach that is too full.
Is Nasal Regurgitation Dangerous
Simple nasal regurgitation is a harmless, non-forceful event that infants naturally outgrow. This is often called “functional infant regurgitation,” meaning the symptom causes no tissue damage or negative health effects. As long as the baby is comfortable, feeding well, and gaining weight appropriately, an occasional incident is not a cause for concern.
A parent’s main concern is the difference between simple regurgitation and aspiration, which is when liquid enters the airway or lungs. True aspiration is rare but serious, potentially leading to respiratory issues like aspiration pneumonia. Nasal regurgitation is typically a minor overflow event, and the infant’s natural reflexes usually protect their airway effectively. The issue usually resolves as the baby’s digestive system matures, often peaking around four months and disappearing by 12 to 18 months.
Managing the Situation and Prevention
If milk comes out of the nose, the immediate action is to remain calm and gently clear the nostrils with a soft cloth or tissue. Comforting the baby is important, as the experience can be startling for them. Once the incident is over, the focus shifts to preventative feeding techniques.
Preventative Feeding Techniques
A simple way to reduce regurgitation is to use gravity by holding the baby in an upright position during feeding, ideally at a 30 to 45-degree angle. Frequent burping is also helpful, as it releases swallowed air that can otherwise force milk back up. For bottle-fed babies, switching to a slow-flow nipple and practicing paced feeding helps ensure they are not drinking too quickly. After a feed, keep the baby upright for about 15 to 30 minutes to allow the milk to settle properly in the stomach.
When to Call the Pediatrician
While nasal regurgitation is often benign, certain signs suggest the need for professional medical evaluation. A primary concern is a failure to gain weight, or actual weight loss, which indicates the baby is not retaining enough nutrition. Another red flag is if the regurgitation is consistently forceful or “projectile” with every feed.
Parents should also contact their pediatrician if the milk coming from the nose is green, yellow (bile), or contains blood, as this can signal a more serious underlying issue. Other concerning symptoms include signs of respiratory distress, such as frequent coughing, gagging, or choking during or after feeding, or difficulty breathing. Excessive fussiness, discomfort, or arching of the back during or after feeds may also suggest a more severe form of reflux that requires treatment.