Bloody nipple discharge is a rare but distressing finding in neonates and infants. We report an 8-month-old boy who showed bilateral bloody nipple discharge for 5 months without signs of infection. Ultrasound examination revealed dilated mammary ducts. This benign phenomenon is most likely caused by mammary duct ectasia. On the background of the reviewed literature, intensive investigations should only be performed in neonates and infants if bloody nipple discharge is unilateral, continues, expands in size or shows signs of inflammation. We discuss the clinical management of nipple discharge during infancy and childhood.