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Background: Salivary gland anlage tumor (SGAT) is a rare but benign tumor of the nasopharynx that most commonly presents with symptoms of obstruction, including severe respiratory distress. There are multiple reports of SGAT in the literature proposing it as an important differential diagnosis of nasal obstruction in the early weeks of life. However, primary manifestations other than respiratory distress have not been reported with SGAT. Case report: An18-hour-old neonate presented with feeding intolerance and coffee ground vomiting since the 6thhour of birth and was admitted to the neonatal intensive care unit. An orogastric tube was inserted for irrigation, and secretions were persistently bloody after 24 hours. At the 36th hour of birth, mild subcostal retraction developed with a slight increase in the respiratory rate as well as bloody secretions from the nose.  At the 48th hour, subcostal retraction became severe accompanied by tachypnea. All symptoms resolved completely within 2 hours of spontaneous vomiting containing a polypoid mass. Conclusion: The SGAT should be considered a differential diagnosis of nasopharyngeal obstruction in the early weeks of life.