Milk coming out of your baby’s nose, known as nasal regurgitation, can be alarming, especially when it happens while the baby is sleeping. This occurrence is quite common in infants and is generally not a sign of a serious illness, but rather a normal part of a baby’s developing anatomy and physiology. Up to 67% of healthy infants experience some form of regurgitation in their first three months of life, which often resolves naturally as they grow.
Understanding Nasal Regurgitation
The primary reason milk exits through an infant’s nose is the unique anatomical connection between the throat and the nasal passages. The distance between the back of the throat (pharynx) and the nasal cavity is relatively short in babies, making it easier for refluxed liquid to travel upward and out. This close proximity, combined with the fact that infants spend a lot of time lying flat, sets the stage for nasal regurgitation.
The digestive system’s immaturity is the main physiological driver of this reflux. The lower esophageal sphincter (LES), a ring-like muscle that acts as a valve between the esophagus and the stomach, is not yet fully developed in infants. This immaturity causes the LES to relax more often than in adults, allowing stomach contents to flow back up the esophagus.
Reflux is often triggered by simple external factors, such as swallowing air during a feed, which creates pressure in the stomach, or overfeeding, which physically overfills the stomach. When the stomach is full, any sudden pressure change—like a burp or being laid down—can push the contents back up. The milk can then easily divert into the nearby nasal passages.
Management and Feeding Adjustments
Simple adjustments to feeding routines can significantly reduce the frequency of nasal regurgitation. Keeping your baby in an upright or semi-upright position during the entire feeding allows gravity to assist the milk flow toward the stomach. This position should be maintained for 20 to 30 minutes after the feeding is complete to allow the stomach contents to settle.
Feeding smaller amounts of milk more frequently helps prevent the stomach from becoming overly full, reducing the likelihood of a forceful spit-up. If bottle-feeding, switching to a slow-flow nipple helps control the rate of milk delivery and prevents the baby from gulping excessive air. For breastfeeding, ensuring a proper latch also minimizes air intake.
Burping your baby mid-feed and again at the end is an effective strategy to release trapped air before it can contribute to regurgitation. Gentle burping is recommended, as vigorous movements or pressure on the baby’s abdomen immediately after a large meal can inadvertently trigger reflux.
When to Contact a Pediatrician
While occasional nasal regurgitation is normal, certain signs indicate the need for a medical evaluation. The most significant concern is poor weight gain or a failure to thrive, which suggests the baby is not retaining enough nutrition. Persistent coughing, choking, or gagging during feeds, or signs of difficulty breathing, may suggest that milk is entering the airway (aspiration) and requires immediate attention.
You should also contact a healthcare provider if the regurgitated milk appears abnormal in color, such as yellow or green (indicating bile), or contains blood. Forceful, projectile vomiting, which is distinct from an effortless spit-up, should also be reported. If the baby shows other signs of illness, such as a fever, or is excessively irritable and uncomfortable during or after every feeding, a medical consultation is warranted.