Question:
I attended your lecture in Christchurch, New Zealand 2010. You mentioned a baby who experienced milk coming out of his nose when breastfeeding or burping. I have a client with a baby who is experiencing this issue. Can you please comment?
Yvonne Martin
Answer:
Dear Yvonne,
I reviewed my case reports and recalled a video I showed where the baby had stuffy, congested-sounding breathing. In this case, the mother had a strong milk ejection and we surmised that milk was aspirating up into the nasal passages and contributing to congestion. The fact that milk can get up into the nasal passages explains why it may also sometimes drip out of the nose. Sometimes even older kids and adults experience fluid leaking from their noses — this can happen when they are laughing or choking.
Kay
I agree with Kay. Forceful milk ejection may occasionally overwhelm the baby’s ability to swallow the rapidly flowing milk. There are several other scenarios that may cause nasal regurgitation. You may observe babies who are overly full who will burp up milk from both the nose and mouth. Some infants with low muscle tone have trouble with rapid swallowing, particularly when they become fatigued. They may occasionally get overwhelmed and regurgitate milk from the nose and mouth.
Gastroesophageal reflux disease (GERD) may also cause spitting up, including nasal regurgitation. Infants with GERD typically do not gain weight robustly. Finally, infants with sub-mucosal clefts of the palate may have issues with nasal regurgitation. A sub-mucosal cleft may be visualized by shining a small flashlight beam on the palate. If there is a cleft under the surface of the skin, it is visible as a dark hole.
Generally speaking, if the infant is growing well, is meeting developmental mile stones, and acts reasonably happy, spitting up is not too worrisome — even if you sometimes see milk coming out of the nose! As Kay mentions, nasal regurgitation may indeed contribute to stuffy breathing. Blocked nasal passages can cause some babies to refuse to breastfeed. Vigorous aspiration of the nasal passages with bulb syringes should be avoided because this may cause even more swelling of the nasal membranes. A few drops of mild, infant-strength saline nose drops is gentler and may be more helpful in keeping the nasal passages clear.
It is always a good idea to mention your concerns and observations to the child’s primary health care provider.
Barbara
