When milk exits a baby’s nose, it is called nasal regurgitation. While alarming to witness, this occurrence is exceedingly common in infants, with up to 67% of healthy newborns experiencing some form of regurgitation in their first three months. The appearance of milk through the nose is generally a benign consequence of the baby’s still-developing anatomy and digestive system. This involuntary backflow is typically not a sign of a serious health problem.
The Anatomical Pathway
The path milk takes from the mouth to the nose is a direct result of the connection between the oral cavity and the nasal cavity in the back of the throat. During a normal swallow, the muscular soft palate, or velum, automatically elevates to seal off the nasopharynx, which is the upper part of the throat leading to the nose. This action acts like a valve, ensuring the milk is directed down the esophagus toward the stomach.
In infants, this coordinated swallowing mechanism is still maturing, and the soft palate’s closure may sometimes be incomplete or poorly timed. Additionally, an infant’s anatomy is more compact than an adult’s, with a relatively high larynx. The shorter distance between the throat and the nasal passages means that if milk is forcefully pushed back up, it has a very short pathway to exit through the nose. When milk backs up into the throat due to reflux or pressure, the momentary failure of the soft palate to completely seal the passage allows the liquid to escape upward.
Common Feeding Triggers
Nasal regurgitation often occurs when the volume of milk or the speed of the feed overwhelms the baby’s small stomach and immature digestive system. Overfeeding is a primary cause, filling the stomach beyond its capacity. This excess volume creates pressure that the lower esophageal sphincter (LES)—the ring-like muscle separating the esophagus and stomach—cannot contain, leading to backflow.
The rate of milk flow is another significant factor, particularly in cases of a forceful let-down during breastfeeding or using a fast-flow nipple with a bottle. When milk flows too quickly, the baby may gulp, swallowing a considerable amount of air along with the liquid. This trapped air increases the pressure inside the stomach, which can then push milk back up and out through the nose. The immaturity of the LES, which is weak in infants, makes it easier for this pressure to force the milk upward.
Prevention and Management Strategies
Adjusting your feeding technique is the most effective way to manage and reduce the frequency of nasal regurgitation. Always feed your baby in a slightly upright, semi-vertical position. This technique allows gravity to assist in keeping the liquid in the stomach, reducing the likelihood of reflux and subsequent nasal escape.
It is also beneficial to keep your baby’s head elevated higher than their stomach for at least 20 to 30 minutes after the feeding is complete. Frequent burping during the feed, rather than waiting until the end, helps release swallowed air before it builds up pressure in the stomach. For bottle-fed infants, using a slow-flow nipple is recommended to control the rate of intake, and paced feeding—taking breaks during the feed—mimics the natural pauses a baby takes during breastfeeding.
When to Consult a Pediatrician
While nasal regurgitation is usually a harmless symptom of a developing digestive system, certain associated signs warrant immediate medical evaluation. Consult a pediatrician if your baby is not gaining weight appropriately or is actively losing weight, a condition known as failure to thrive. This suggests the baby is not retaining enough nutrients. Another sign for concern is recurrent, forceful, or projectile vomiting, which differs from gentle spit-up. Other red flag symptoms require professional assessment:
- Milk or spit-up that is green, yellow, or contains blood.
- Significant discomfort or excessive crying.
- Obvious refusal to feed.
- Difficulty breathing or persistent coughing.
- Choking associated with feeds.