Choanal Atresia: A Newborn Breathing Condition

Choanal atresia is a rare condition present at birth that affects a baby’s ability to breathe through the nose. I had never heard the term until my oldest daughter was born and diagnosed with it, and for a time, it became a constant part of my everyday life. This condition often appears immediately after birth and requires early medical care.

What Is Choanal Atresia?

Choanal atresia occurs when the back of the nasal passage is blocked, preventing air from moving freely from the nose into the throat. The blockage may be made of bone, soft tissue, or a combination of both.

It may affect:

• One nostril (unilateral)
• Both nostrils (bilateral) - the more serious form

Because newborns are natural nose breathers, any blockage can quickly interfere with breathing and feeding.

Why Does Choanal Atresia Happen?

Choanal atresia develops early in pregnancy while facial structures are forming. Normally, thin tissue in the nasal passage opens before birth. When choanal atresia happens - that opening never fully forms.

The exact cause is often unknown. It may be related to developmental changes during pregnancy or genetic factors, but in many cases, it occurs on its own. It is not caused by anything a parent did or didn’t do.

Signs and Symptoms

How and when choanal atresia is noticed depends on whether one or both nasal passages are affected.

Bilateral Choanal Atresia

Bilateral choanal atresia is usually recognized immediately after birth because newborns depend on nasal breathing. Symptoms often appear right away and may include:

• Difficulty breathing, especially when resting
• Bluish coloring around the lips or face
• Breathing improves when crying
• Feeding difficulties
• Noisy or labored breathing

Unilateral Choanal Atresia

Unilateral choanal atresia may not be obvious at birth. Because one nasal passage remains open, some babies appear stable and may go home without a diagnosis. Symptoms can develop gradually and may include:

• Persistent congestion on one side
• Drainage from one nostril
• Noisy breathing
• Recurrent sinus or ear infections

How Choanal Atresia Is Diagnosed

Doctors often suspect choanal atresia when they cannot pass a small tube through a newborn’s nostrils. Diagnosis is typically confirmed with imaging such as a CT scan, which shows the location and type of blockage.

Early diagnosis is important so breathing can be supported and treatment planned.

Treatment for Choanal Atresia

Treatment depends on severity and whether one or both nasal passages are affected.

Babies with Significant Blockage May Need

• Oxygen support
• Temporary oral airways
• Close monitoring during feeding

Surgery and Stents

Surgery is needed to open the airway so breathing can happen normally. The focus is on opening the passage and making sure it stays open as it heals. This is usually done through the nose. Stents may be placed for a period of time to help keep the airway open during recovery.

My Experience

When my daughter was born, she was taken from me almost immediately. She was placed in an incubator and transferred to the local children’s hospital. I was able to touch her, but I don’t remember holding her. Everything happened so fast and she had her first surgery the very next day.

After this surgery, stents were placed in her nose to keep her airway open. I was taught how to suction her nose, and it became part of my everyday life. I had to suction her nose between feedings, during feedings, and keep a constant watch on her breathing. Feeding her wasn’t something I did casually - it required constant attention.

Each time the stents were removed, the same thing eventually happened. The bone and tissue would grow back and close the airway again. That meant another surgery. This went on repeatedly as she grew. By the time she was nine months old, she had already been through multiple surgeries.

Every time we had a scheduled surgery and brought her in, all the nurses knew her and made sure to come see her. I don’t remember her ever crying through any of it - not even waking up from surgery. She always had a smile and was happy to see us all.

Laser surgery was fairly new around the time of her final procedure. It involved laser surgery to reopen the airway. After that, the doctors performed a skin graft using tissue taken from the roof of her mouth. That final surgery worked. The airway stayed open, and she did not need additional surgeries after that.

Supportive At Home Care

Choanal atresia isn’t something that can be treated at home. Because it involves a blocked airway, medical care is necessary. That said, supportive measures - like careful suctioning, humidified air, and positioning during feedings - can help with comfort and day-to-day care, always under a doctor’s guidance. For parents, having support and simple routines can make a demanding situation more manageable.

Supportive Care for Babies

These aren’t cures - they’re comfort and support, and always used with medical guidance:

• Saline drops or spray, if recommended by a doctor, to help keep nasal passages moist
• Careful suctioning, as instructed by medical staff, especially before or during feedings
• Upright positioning during feeding, which can make breathing a little easier
• Humidified air, which may help keep airways from drying out

Anything involving a baby’s airway should always be cleared with a pediatrician or ENT first.

Support for Moms and Caregivers

This part often gets overlooked, but it matters.

• Rest whenever possible, even in short stretches
• Simple routines, especially around feeding and care, to reduce mental overload
• Support from nurses, family, or other parents, even brief conversations
• Calming practices like deep breathing, quiet time, or writing things down - especially when days blur together

There’s no home remedy for watching your child go through medical care, but having support and simple routines helps.

Choanal Atresia Outlook

With proper treatment, once the airway stays open, breathing and feeding get easier, and most children do just fine as they grow. As my daughter got older, her doctors explained there was a chance she might need another surgery later on to widen her nostrils as her face developed, but over time they didn’t feel it would be necessary.

For the most part, she’s been fine and is now in her 40s. Choanal atresia is rare, and many parents don’t hear about it until it affects their own child - I certainly hadn’t.