Why is Milk Coming Out of My Baby's Nose with Cleft Palate?

Seeing milk come out of your baby’s nose during a feed can be terrifying, but it is generally not dangerous. This is known as nasal regurgitation, and it is incredibly common—and fully expected—in infants with an unrepaired cleft palate ^[1][2]. It is important to know that milk coming out of the nose is not the same thing as choking.

Why Nasal Regurgitation Happens

When a baby has a cleft palate, there is a natural physical opening between the roof of their mouth (the oral cavity) and the floor of their nose (the nasal cavity) ^[2][3]. Normally, the palate acts as a barrier that closes off the nose during swallowing. Without that solid barrier, milk can easily flow upward into the nasal passages and come out of the baby’s nose ^[2]. While it looks alarming, the milk is simply taking the path of least resistance.

Practical Tips for Managing Feeding

Although nasal regurgitation is not dangerous, it can be uncomfortable for your baby and stressful for you. You can help minimize the amount of milk that enters the nose with a few simple adjustments to your feeding routine:

• Use required specialized bottles: Because babies with a cleft palate cannot create the suction needed to pull milk from a standard bottle, specialized cleft-adapted feeding systems are strictly required ^[4]. Tools like Dr. Brown’s Specialty Feeding System or a Haberman feeder are specifically designed for this purpose ^[5]. Your team may also suggest a custom palatal obturator—a removable device that acts like a temporary roof of the mouth—to help separate the mouth and nose ^[2][6].
• Keep your baby upright: Hold your baby in an upright or semi-upright position during the feed and for 20 to 30 minutes afterward ^[7]. Gravity will help pull the milk down into the stomach. This upright position also helps prevent milk from pooling and entering the Eustachian tubes (which connect the throat to the middle ear), reducing the risk of ear infections ^[8].
• Pace the feed: Try not to let your baby drink too fast. You can pace the feed by tipping the bottle down to stop the flow of milk every few sucks. This gives your baby time to swallow properly and prevents milk from overwhelming the space in their mouth ^[7].
• Burp frequently: Babies with a cleft palate tend to swallow more air during feeds, which can push milk back up ^[7]. Frequent burping can help manage this extra air.

What to Do When Regurgitation Happens

When milk does come out of your baby’s nose, stay calm. Gently wipe the milk away from their face with a soft cloth. Avoid constantly using a bulb syringe to suction their nose; your baby’s natural sneezing is the most effective and gentle way for them to clear the nasal passages.

Knowing When to Worry: Regurgitation vs. Respiratory Distress

It is completely normal to worry about your baby’s breathing when milk comes out of their nose. However, there is a distinct difference between standard regurgitation and actual respiratory distress ^[1][2].

Nasal regurgitation simply means milk is in the nasal passages. Your baby might sneeze or sound a little “snorty” as they clear the milk, but they will continue to breathe safely.

True respiratory distress means your baby is actively struggling to get enough air into their lungs ^[1][2]. Seek immediate medical attention if you notice any of the following signs:

• Cyanosis: Turning blue around the lips, face, or chest.
• Retractions: Skin pulling in deeply around the ribs, collarbone, or neck with each breath.
• Nasal flaring: The nostrils opening wide with every breath.

If your baby is just sneezing out milk but otherwise breathing comfortably and their skin color is normal, they are likely just experiencing standard nasal regurgitation.