My Baby Was Born with Blocked Nasal Passages (Choanal Atresia)
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.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
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 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
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
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.
How to Advocate for Your Child's Needs
You know your child better than anyone, and your observations matter. If you feel something is not right with your child's development or health, you have every right to ask questions, request evaluations, and seek second opinions. Advocating for your child is not being difficult - it is being a good parent.