Choanal atresia presents with which classic pattern of respiratory symptoms?

• A. Cyanosis at rest that worsens with crying
• B. Cyanosis that changes with crying but remains
• C. No change with crying
• D. Cyanosis at rest that improves with crying

Answer: (D)

In newborns, breathing is primarily through the nose. If both nasal passages are blocked (choanal atresia), the infant becomes cyanotic when at rest because air can’t reach the lungs through the nose. When the baby cries, the mouth opens and air can be drawn in through the oral route, bypassing the blocked nasal airway, which often improves oxygenation and the color. This pattern—cyanosis at rest that improves with crying—is the classic clue for choanal atresia. Unilateral disease or other patterns don’t fit the typical nasal obstruction in newborns as well.