It is normal for an infant to breathe only through its nose. Mouth breathing is never normal at any age. Any nasal obstruction in the newborn involves and imminent risk of suffocation because the infant does not breathe through the mouth during the first two to six or more weeks of life. Bilateral choanal atresia in the neonate is an example of such life threatening condition that calls for immediate recognition and treatment. Recently the authors have experienced a case of bilateral choanal atresia in 3 days old female with complaints of feeding difficulty and mouth breathing. Bilateral choanoplasty was performed by using transnasal approach with mastoid curette. The stent was maintained for 6 weeks. Follow up at 6 months showed good nasal flow bilaterally.