Newborns generally prefer to breathe through their nose. Typically, infants only mouth breathe when they cry. Babies with choanal atresia have difficulty breathing unless they are crying.

Choanal atresia may affect one or both sides of the nasal airway. Choanal atresia blocking both sides (bilateral) of the nose causes acute breathing problems with cyanosis and breathing failure. Infants with bilateral choanal atresia may need resuscitation at delivery. More than half of infants have a blockage on only one side, which causes less severe problems.

Symptoms include:

• Chest retracts unless the child is breathing through mouth or crying
• Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying
• Inability to nurse and breathe at same time
• Inability to pass a catheter through each side of the nose into the throat
• Persistent one-sided nasal blockage or discharge

A physical examination may show an obstruction of the nose.

Tests that may be done include:

• CT scan
• Endoscopy of the nose
• Sinus x-ray