When babies are breastfeeding, they learn to coordinate sucking, swallowing, and breathing.
This is a complex process; for some babies, it may take more time to fully master it. And sometimes milk comes out of baby’s nose.

In another article, we have discussed what causes spitting up or vomiting, so today, we will try to shed some light on a more complex matter: what happens and why does it happen when a baby brings up milk, and it comes out from their nose?

Should I be worried if milk comes out of my baby’s nose?

Several different theories explain this, and it undoubtedly worries families a lot. It is important to clarify that this doesn’t happen to all babies and can even happen to a baby only occasionally.

When nasal regurgitation (bringing up milk and it coming out through the nose) happens during feeding and does not go away as the baby gets older and/or is suspected to affect the baby’s growth, medical assistance is necessary to determine the cause.

What are the causes?

Among the most common circumstances in which nasal regurgitations may occur are the following:

Physical immaturity

Babies have immature parts of their digestive system. In some cases, the muscles and valves that control milk flow down the throat and prevent it from entering the nose are not yet fully developed.

This can allow breast milk to flow into the back of the throat and occasionally back up into the nose, causing nasal reflux.

At the end of the palate, the soft palate also acts as a valve because when the baby breastfeeds, the structure closes and lets the milk flow towards the esophagus, protecting the nasopharynx, which is the backmost part of the nasal cavity.

Disorder/s of oral structures

This is a slightly different case, as it applies to babies who, from birth, have a cleft in some area of the palate, either hard or soft. This means that the palate, which separates the nose from the mouth, has not closed, and there is a connection.

This open connection may result in a tendency for milk to come out of the nose while the baby is breastfeeding. You might not always see a large amount of milk; sometimes, you just see a continuous dribble of milk from the nose.

Suction strength

The baby’s sucking strength can also play an important role. Some babies have a stronger, more vigorous sucking than others, which can cause milk to flow more quickly down the throat and, in some instances, towards the nose.

Baby’s position during feeding at the breast

The position of the baby during breastfeeding can influence the direction of milk flow. If the baby is in a position that allows milk to flow easily into the throat and nose, nasal reflux is more likely to happen.

Sometimes, babies have nasal reflux only in certain positions. These usually involve babies lying flat, either in bed or in the cradle-hold position.

If this is your case, try to find a way to keep the baby’s head higher than the rest of the body during breastfeeding so that breast milk is less likely to flow up and out the baby’s nose.

Overproduction of breast milk or hyperactive milk ejection reflex

Whether there is an overproduction (hypergalactia) of breast milk or it is limited to times when there is a very strong milk ejection reflex, your baby may have difficulties managing the milk flow and not be able to swallow easily.

We also need to consider that these maternal conditions of oversupply of breast milk are often associated with oral difficulties of the baby, such as a tongue-tie.

Tongue-tie or impaired mobility of the tongue

Tongue-tie is a condition that prevents babies from performing optimal sucking and swallowing movements. This causes the baby to look for ways to get the milk they need by making what we call compensation movements with the oral muscles.

These movements can lead to a poor latch in which babies swallow air (known as aerophagia). This accumulation of small amounts of air in the stomach can then act as a “propellant” for the milk, and breast milk can be pushed out through the nose.

Usually a temporary condition

It is important to note that in most cases, nasal reflux during breastfeeding is not a cause for concern and does not cause serious complications. It tends to improve as the baby grows and all structures fully develop.

It is important to observe the baby’s behavior when nasal regurgitation occurs, even as this is a benign condition: if the baby seems to be struggling to breathe or is having significant difficulties feeding, then medical attention should be sought immediately.

The right specialist to assess these situations would be a speech therapist specializing in myofunctional therapy.