Nodding spurge is native across the eastern and central United States and into southeastern Canada, ranging south through Central America, the Caribbean, and into Colombia and Venezuela. Its specific epithet, nutans, means drooping, which describes the way the branch ends tend to lean as plants mature. The stems are pinkish-red and hairy when young, and each green leaf carries a red blotch on its upper surface. It colonizes roadsides, disturbed ground, river margins, and gardens with equal willingness.

As an ornamental it is generally passed over, but in native meadow plantings or informal lawn areas it has a modest ecological role, attracting bees to its small clusters of greenish-pink and white flowers in late summer and fall. Like all euphorbias it produces a milky sap, and this one can cause skin rashes on contact. Management in gardens is the same as for other spurge species: remove young plants before they set seed, since the plants flower early and seed dormancy is minimal. Pre-emergence herbicides provide effective control in managed beds.