Excessive Drooling in Infants

Any parent of an infant is no stranger to drool. Drooling is a common for babies during the developmental phase where their focus is primarily oral – usually from about 3 to 6 months of age.

Beyond this phase, drooling is still a fairly standard occurrence in healthy children under 2 years of age. Saliva has many necessary functions. It keeps the mouth moist, making it easier to swallow and soothing a baby’s gums while they are teething, for example.

Sometimes it may seem like your child is drooling a little too much. Typically, clinically excessive drooling involves low muscle tone, a lack of sensitivity in the lips and face, and difficulty swallowing. Although some drooling is normal in children up to 2 years of age, excessive drooling is also a commonly observed symptom in neurologically impaired children. It’s important to consult with your health care provider, as excessive drooling could potentially be a symptom of a more serious condition caused by a birth injury.

Common Causes of Excessive Drooling

Parents – especially new parents – worry about everything. Drooling is very normal. But if it’s excessive, it might mean they are struggling with swallowing, and it could be down to a range of reasons, from teething to medical conditions like reflux or infections

Usually, excessive drooling can be attributed to several factors. It’s quite common during infancy, especially when the baby is between 3 to 6 months old. Again, teething is often the culprit. This period often coincides with the beginning of teething and the baby’s development stage where their world revolves around their mouth. Saliva can soothe tender gums as new teeth emerge, which may contribute to the increased drooling. If your baby is excessively drooling and appears ill, it could be a sign of trouble swallowing, and you should consult a pediatrician​​.

Some medical conditions can also cause excessive drooling. In children, issues like cerebral palsy or other neurological disorders can lead to drooling because of challenges with muscle control required for swallowing. Gastroesophageal reflux disease, infections, and reactions to certain medications might also cause increased saliva production​​.

You want to keep an eye out for whether the drooling is accompanied by any other symptoms that could indicate an underlying health issue. If the drooling persists or if there are other concerning symptoms, a healthcare provider should assess the infant to rule out other causes and discuss potential treatments. This can include strengthening exercises for muscles, improving coordination and sensation for swallowing, and possibly medications to reduce saliva production if necessary​​​

Drooling is typical in young children, especially before they fully develop control over their mouth muscles, which usually happens by 18-24 months of age. But, if a child over 4 years old is still drooling a lot, it’s generally not considered normal. Kids with neurological issues might take a little longer, up to about 6 years old, to gain this control. That’s why doctors usually wait until around this age before thinking about more intensive treatments for drooling.

In cases of cerebral palsy, one of the affected muscular functions is oral muscular control, meaning that a child with CP will drool almost constantly. The drooling is usually related to:

• Abnormalities in swallowing
• Difficulty moving saliva to the back of the throat
• Poor mouth closure
• Jaw instability
• Tongue thrusting

Keep in mind that uncontrollable drooling is only one of many symptoms of cerebral palsy. Before you assume that your child has this disorder, you should first consider whether they display any other symptoms. Children with cerebral palsy will also have writhing or spastic muscular movements, stiff muscles, inconsistencies in their muscle tone, and developmental delays.

When Bell’s palsy occurs, the function of the facial nerve is disrupted, interrupting the link between the brain and facial muscles. As a result, people with Bell’s palsy experience facial weakness or partial paralysis. Bell’s palsy happens because the facial nerve becomes swollen and inflamed, likely due to a viral infection.

If your child develops Bell’s palsy, they will have a droopy, dry eyelid on one side of their face in addition to excessive drooling. Fortunately, Bell’s palsy is a temporary condition that can be treated with medication obtained from your health care provider.

For children diagnosed with autism, treatment options for drooling must be personally tailored to the child. Explore possible treatments with your child’s health care provider. For example, a speech-language pathologist or occupational therapist experienced in oral-sensitivity and muscle tone issues could potentially help.

Treatment for Excessive Drooling

There are a variety of treatment options for excessive drooling in babies. The effectiveness of these treatments often depends on the underlying cause of the drooling.

Lip Muscle Exercises
Exercises that strengthen the muscles around the lips can help significantly with excessive drooling. The best “exercises” for the lips are puckering, blowing bubbles, making a “kiss” form, and making funny faces with the lips. Doing these regularly will help increase lip closure and reduce the escape of saliva.

Tounge Muscle Exercises
Developing and strengthening the tongue muscles will reduce drooling by enabling the child to more effectively swallow saliva. Tounge exercises include sticking out the tongue, moving it around vertically and horizontally, or putting a small piece of food (like a pea) on the tongue and having the child move it without touching their teeth.

Oral Sensory Activities
Oral sensory activities will help with drooling that is caused by the child not being able to sense when saliva is in the mouth. Oral sensory exercises include things like brushing the tongue, lips and roof of the mouth with something soft and textured, like a toothbrush or cloth. Licking ice cubes and sour candy can also help.

Further Readings

Sforza, E., et al. (2022). Drooling outcome measures in paediatric disability: a systematic review. European Journal of Pediatrics, 1-18.

This study found that a combination of quantitative measures and parental questionnaires might adequately measure drooling in children.

Daniel, Sam J., et al. “Comprehensive management of anterior drooling: an International Pediatric Otolaryngology Group (IPOG) consensus statement.” International journal of pediatric otorhinolaryngology 168 (2023): 111500. This study conducted a survey of expert opinions from pediatricians on the most effective treatment methods for excessive drooling.

Bekkers, S., et al. (2021). Repeated onabotulinum neurotoxin A injections for drooling in children with neurodisability. Developmental Medicine & Child Neurology, 63(8), 991-997. This study looked at the effectiveness of repeated Botox injections for the treatment of drooling in children with neurodisabilities. The researchers found that Botox injections remained effective throughout a patient’s treatment course. However, they found that the effect was diminished after each successive injection.

Delsing, C. P., et al. (2021). Posterior drooling in children with cerebral palsy and other neurodevelopmental disorders. Developmental Medicine & Child Neurology, 63(9), 1093-1098. This study looked at whether Botox injections, submandibular gland excisions, and bilateral submandibular duct ligations controlled drooling in children with neurological impairments. The researchers found that all three could treat drooling. They also found that submandibular gland excisions were the most effective.

Riva, A., et al. (2021). Exploring treatments for drooling in children with neurological disorders. Expert Review of Neurotherapeutics, 21(2), 179-187. This study looked at the challenges of treating drooling in children with neurological disorders. The researchers reported that the lack of reliable metrics that assess safety outcomes and efficacy limited researchers from identifying the best treatments. They highlighted the need for accurate metrics to better measure drooling treatment effectiveness.

Speyer, R., et al. (2019). Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta‐analyses. Developmental Medicine & Child Neurology, 61(11), 1249-1258. This systemic review determined the prevalence of drooling, swallowing, and feeding problems in people with cerebral palsy (CP) throughout their lives. The results from 42 studies showed that drooling, swallowing, and feeding problems are very common in people with CP. As such, they experience an increased risk of malnutrition and dehydration, aspiration pneumonia, and poor quality of life.

Wang, L. et al. (2018). Drooling in cerebral palsy and its relationship with dysphagia and gross motor functioning. Chinese Journal of Physical Medicine and Rehabilitation, 12, 118-122. This article looked at the drooling incidence and severity in children with cerebral palsy to determine whether there were possible correlations with oral dyskinesia, dysphagia, and gross motor function. Researchers found that one-third of the children with cerebral palsy suffered from drooling, leading them to conclude that there is a correlation between drooling severity and cerebral palsy, oral dyskinesia, dysphagia, and GMFCS levels.