My Baby Was Born with Blocked Nasal Passages (Choanal Atresia)
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published NIH, Boston Children's, AAO-HNS guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect was born with blocked nasal passages (choanal atresia), here is what the evidence says.
The short answer
Choanal atresia is a condition present at birth where one or both nasal passages are blocked by bone or tissue. Since newborns are obligate nose-breathers (they breathe primarily through their nose), bilateral choanal atresia (both sides blocked) is a medical emergency that is usually detected immediately after birth. Unilateral choanal atresia (one side blocked) may not be diagnosed until later. Treatment is surgical, and outcomes are generally very good. About half of babies with choanal atresia have other associated conditions, so a thorough evaluation is important.
Key takeaways
- Choanal atresia is a condition present at birth where one or both nasal passages are blocked by bone or tissue. Since newborns are obligate nose-breathers (they breathe primarily through their nose), bilateral choanal atresia (both sides blocked) is a medical emergency that is usually detected immediately after birth. Unilateral choanal atresia (one side blocked) may not be diagnosed until later. Treatment is surgical, and outcomes are generally very good. About half of babies with choanal atresia have other associated conditions, so a thorough evaluation is important.
- Usually normal when: Your baby had successful choanal atresia repair and is breathing and feeding well
- Call your doctor if: Your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately
- Varies by age — see the age-by-age breakdown below
“Fever itself is not an illness — rather, it is a sign or symptom that the body is fighting an infection. Fever stimulates certain defenses, such as the white blood cells, which attack and destroy invading bacteria.”
Parents everywhere have the same worry. You are doing the right thing by looking into it.
What Parents Should Know
According to NIH, Boston Children's, AAO-HNS guidelines, choanal atresia is a condition present at birth where one or both nasal passages are blocked by bone or tissue. Since newborns are obligate nose-breathers (they breathe primarily through their nose), bilateral choanal atresia (both sides blocked) is a medical emergency that is usually detected immediately after birth. Unilateral choanal atresia (one side blocked) may not be diagnosed until later. Treatment is surgical, and outcomes are generally very good. About half of babies with choanal atresia have other associated conditions, so a thorough evaluation is important. At Newborn — immediate postnatal period, bilateral choanal atresia presents dramatically at birth — the baby has severe breathing difficulty that worsens when the mouth is closed and improves when crying (because crying opens the mouth). An oral airway or endotracheal tube may be placed to stabilize breathing. Unilateral choanal atresia is often less obvious — the baby may have one-sided nasal congestion or difficulty feeding. Diagnosis is confirmed when a small catheter cannot pass through the nasal passage, followed by CT imaging. It is generally considered normal when your baby had successful choanal atresia repair and is breathing and feeding well. However, you should contact your pediatrician promptly if your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately.
Normal vs. Concerning
When to Seek Immediate Care
- Your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately
- Your baby's nasal stent has come out or become dislodged — contact your ENT surgeon urgently
- Your baby is unable to feed and shows signs of dehydration — seek immediate medical care
By Age
What to expect by age
Newborn — immediate postnatal period
Bilateral choanal atresia presents dramatically at birth — the baby has severe breathing difficulty that worsens when the mouth is closed and improves when crying (because crying opens the mouth). An oral airway or endotracheal tube may be placed to stabilize breathing. Unilateral choanal atresia is often less obvious — the baby may have one-sided nasal congestion or difficulty feeding. Diagnosis is confirmed when a small catheter cannot pass through the nasal passage, followed by CT imaging.
0-3 months (surgical repair)
Surgery to open the blocked passage(s) is performed, typically through the nose (transnasal approach). Stents may be placed in the nasal passages after surgery to keep them open during healing. Stent care requires regular suctioning and saline drops, which your medical team will teach you. The surgery has a high success rate, though some children need a second procedure if the opening narrows (restenosis).
3-12 months
After successful repair, most babies breathe and feed normally. Follow-up includes nasal endoscopy to ensure the repaired passage(s) remain open. If stents were placed, they are typically removed after several weeks. Your ENT surgeon will monitor for restenosis. Feeding often improves dramatically after successful repair, as babies can coordinate breathing and swallowing more easily.
1 year+
Long-term outcomes after choanal atresia repair are excellent. Some children experience occasional nasal congestion or may need additional procedures if scarring narrows the passage. Your doctor may screen for CHARGE syndrome or other associated conditions, especially if there are other findings (coloboma, heart defects, growth issues, ear anomalies). Regular hearing assessments are recommended.
What to Tell Your Pediatrician
- Describe when you first noticed was born with blocked nasal passages (choanal atresia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby seems to be having increasing nasal congestion or noisy breathing after repair.
- Mention if your baby is having difficulty feeding or is not gaining weight well after repair.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Your baby had successful choanal atresia repair and is breathing and feeding well
- Your baby has unilateral choanal atresia and is managing well while awaiting planned repair
- Follow-up endoscopy shows the repaired passage is open and healing well
- Your baby seems to be having increasing nasal congestion or noisy breathing after repair
- Your baby is having difficulty feeding or is not gaining weight well after repair
- You notice your baby seems to breathe primarily through the mouth after the repair was supposed to fix this
- You have questions about whether your baby needs testing for associated conditions
- Your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately
- Your baby's nasal stent has come out or become dislodged — contact your ENT surgeon urgently
- Your baby is unable to feed and shows signs of dehydration — seek immediate medical care
What You Can Do at Home
- Keep track of when you notice was born with blocked nasal passages (choanal atresia) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that your baby had successful choanal atresia repair and is breathing and feeding well — this is generally within the range of normal.
- At Newborn — immediate postnatal period, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately.
Related Conditions
My Baby Was Diagnosed with Pierre Robin Sequence
Pierre Robin sequence (PRS) is a condition present at birth characterized by three features: a small lower jaw (micrognathia), a tongue that falls back in the mouth (glossoptosis), and often a U-shaped cleft palate. The small jaw causes the tongue to sit far back, which can obstruct the airway and make breathing and feeding difficult. While the diagnosis is frightening, the jaw typically grows significantly during the first 1-2 years of life, and most children's airway problems improve substantially. Treatment focuses on ensuring safe breathing and adequate nutrition.
My Baby Was Diagnosed with CHARGE Syndrome
CHARGE syndrome is a complex genetic condition caused by mutations in the CHD7 gene, occurring in about 1 in 8,500-10,000 births. The name stands for Coloboma (eye defect), Heart defects, Atresia choanae (blocked nasal passages), Retardation of growth/development, Genital underdevelopment, and Ear anomalies/deafness. CHARGE affects many body systems and presents differently in each child. While the medical needs can be significant, especially in the early years, many people with CHARGE syndrome live fulfilling lives with appropriate support. Advances in medical care continue to improve outcomes.
Related Resources
Frequently asked questions
Is was born with blocked nasal passages (choanal atresia) normal?
When should I call the doctor about was born with blocked nasal passages (choanal atresia)?
When is was born with blocked nasal passages (choanal atresia) normal?
What causes was born with blocked nasal passages (choanal atresia)?
What should I mention to my pediatrician about was born with blocked nasal passages (choanal atresia)?
Is was born with blocked nasal passages (choanal atresia) normal at Newborn — immediate postnatal period?
Is was born with blocked nasal passages (choanal atresia) normal at 0-3 months (surgical repair)?
Should I go to the ER for was born with blocked nasal passages (choanal atresia)?
Does was born with blocked nasal passages (choanal atresia) go away on its own?
References
- [1]National Library of Medicine. Choanal Atresia. StatPearls, 2024. NIH
- [2]Boston Children's Hospital. Choanal Atresia. Boston Children's
- [3]American Academy of Otolaryngology. Choanal Atresia Clinical Practice. AAO-HNS
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss My Baby Was Born with Blocked Nasal Passages (Choanal Atresia).
Things to mention
- Describe when you first noticed was born with blocked nasal passages (choanal atresia) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if your baby seems to be having increasing nasal congestion or noisy breathing after repair.
- Mention if your baby is having difficulty feeding or is not gaining weight well after repair.
- Let your doctor know if you have noticed any related concerns, such as changes in feeding, sleep, or movement patterns.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Your baby seems to be having increasing nasal congestion or noisy breathing after repair
- Your baby is having difficulty feeding or is not gaining weight well after repair
- You notice your baby seems to breathe primarily through the mouth after the repair was supposed to fix this
Urgent signs to report immediately
- Your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately
- Your baby's nasal stent has come out or become dislodged — contact your ENT surgeon urgently
- Your baby is unable to feed and shows signs of dehydration — seek immediate medical care
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of was born with blocked nasal passages (choanal atresia) are normal. Talk to your pediatrician if your baby is having severe difficulty breathing — turning blue, retracting, or gasping — call 911 immediately.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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Related Medical Concerns
My Baby Was Diagnosed with Pierre Robin Sequence
Pierre Robin sequence (PRS) is a condition present at birth characterized by three features: a small lower jaw (micrognathia), a tongue that falls back in the mouth (glossoptosis), and often a U-shaped cleft palate. The small jaw causes the tongue to sit far back, which can obstruct the airway and make breathing and feeding difficult. While the diagnosis is frightening, the jaw typically grows significantly during the first 1-2 years of life, and most children's airway problems improve substantially. Treatment focuses on ensuring safe breathing and adequate nutrition.
My Baby Was Diagnosed with CHARGE Syndrome
CHARGE syndrome is a complex genetic condition caused by mutations in the CHD7 gene, occurring in about 1 in 8,500-10,000 births. The name stands for Coloboma (eye defect), Heart defects, Atresia choanae (blocked nasal passages), Retardation of growth/development, Genital underdevelopment, and Ear anomalies/deafness. CHARGE affects many body systems and presents differently in each child. While the medical needs can be significant, especially in the early years, many people with CHARGE syndrome live fulfilling lives with appropriate support. Advances in medical care continue to improve outcomes.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.
Adrenoleukodystrophy (ALD) in Babies
X-linked adrenoleukodystrophy (X-ALD) is a genetic disorder affecting about 1 in 17,000 newborns, caused by mutations in the ABCD1 gene on the X chromosome. It primarily affects boys and impairs the breakdown of very long-chain fatty acids (VLCFAs), which accumulate and damage the myelin sheath in the brain and the adrenal glands. The most severe form, cerebral ALD, typically affects boys between ages 4-10 with rapid neurological decline. Newborn screening now enables early detection, and hematopoietic stem cell transplant or gene therapy performed before significant brain involvement can be life-saving.