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What to Know About Excessive Drooling in Children

Medically Reviewed by Dan Brennan, MD on July 23, 2022

Drooling is common in children between the ages of 15 and 19 months. But after the age of 4, excessive drooling can point to an underlying condition. Sialorrhea, also known as hypersalivation, is usually present in children with neurological or anatomical abnormalities. If you’re worried your child has sialorrhea, here’s what you need to know about the causes, symptoms, and treatments.

What Is Sialorrhea?

Sialorrhea is excessive oral secretion, or drooling. Children usually produce up to 1.5 liters of saliva per day, but children with hypersalivation may produce up to 5 liters. This condition may also happen in children who produce an average amount of saliva but can’t swallow properly.

There are two types of sialorrhea:

Anterior sialorrhea. Anterior sialorrhea is what is commonly referred to as drooling. The excess saliva spills onto the child’s face and, if left unchecked, their clothes. This can cause issues with skin care and cleanliness. Because of this, they may also have issues with socializing.

Posterior sialorrhea. Posterior sialorrhea is when the saliva spills down the child’s airway instead of being swallowed. This form of hypersalivation leads to chronic lung irritation, which can cause other health issues.

Children with sialorrhea typically have a combination of anterior and posterior sialorrhea.

What Are the Causes of Sialorrhea?

Sialorrhea in children is often caused by existing underlying diseases. Conditions that affect the brain can cause reduced muscle control, especially around the mouth and throat. This leads to difficulty swallowing saliva and results in excessive drooling.

Excessive oral secretions are common in children who are born with  cerebral palsy, which is a condition that affects the brain’s ability to move muscles. Some studies suggest that up to 58% of children with cerebral palsy also have sialorrhea.

Other conditions that affect motor control of the mouth and throat include stroke,  traumatic brain injuries, and abnormalities in brain development. The severity of the sialorrhea normally depends on the severity of the underlying disease. For example, if the brain injury does not worsen over time, the excessive drooling shouldn't either.

Sialorrhea also happens in children with anatomical abnormalities that lead to physical difficulties swallowing. Hypersalivation causes may include:

  • A large tongue
  • A malformed jaw
  • A malformed throat
  • Orthodontic issues
  • Clefts in the lip, palate, or larynx 

Excessive drooling can also be caused by the child's body producing too much saliva or mucus rather than their inability to swallow. This can happen as a result of other neurological or respiratory conditions or as a side effect of certain medications.

What Are the Symptoms of Sialorrhea?

Hypersalivation symptoms depend on whether the saliva is being drooled onto the child’s face or spilling into their airway.

Children with anterior sialorrhea have visible drooling that is usually accompanied by wet clothing. If the drooling is severe, the child’s bed sheets may also be wet after sleeping.

Constant drooling can lead to facial rashes and the breakdown of skin around the mouth and chin. This can cause some irritation and soreness.

Children with sialorrhea may also have mild dehydration, difficulties with speech, and feeding issues as a side effect of constant drooling.

Children with posterior sialorrhea may have more serious symptoms due to chronic lung irritation and a blocked airway. Symptoms can include:

  • Choking
  • Coughing
  • Gagging
  • Vomiting
  • Congestion
  • Breathing difficulty
  • Aspiration

Aspiration, which is breathing in non-air substances, is especially dangerous as it can lead to  pneumonia.

How Is Sialorrhea Diagnosed?

Healthcare professionals can diagnose anterior sialorrhea by observation. Excessive drooling is an easily identifiable, visible symptom. Posterior sialorrhea diagnosis may need additional tests.

To identify posterior sialorrhea, doctors can use special equipment and procedures to examine the child’s throat as well as their swallowing and speech functions. This often involves the use of videofluoroscopy, which is a specific type of x-ray used to assess swallowing.

How Is Sialorrhea Treated?

Sialorrhea treatments include oral medications, botox injections, surgical procedures, and oral motor training.

Oral medications. Doctors may prescribe oral medications to reduce saliva production or ease the child's airway. The side effects of this medication may be uncomfortable or lead to other health complications. Anticholinergic medications, which are used to ease airways, usually cause dry mouth and constipation.

More serious side effects include fever and thicker secretions, which can cause further respiratory issues. Because of this, medication may only be appropriate for serious cases of hypersalivation in children.

Botox injections. Studies show that botulinum toxin, or botox, can safely treat sialorrhea in children. Doctors can reduce saliva production for around 4 months by injecting botox into the salivary glands.

Surgical procedures. There are many surgeries for the treatment of sialorrhea. Usually, they involve removing or disconnecting some salivary glands from the child’s mouth. By permanently reducing saliva production, some surgeries can curatively treat excessive drooling.

Oral motor training. Children who drool due to physical malformations should consider doing oral motor training, such as speech or swallowing therapy, if they can. This can help them learn how to swallow properly and reduce the amount of excess drool.

Mild cases of sialorrhea may not need aggressive treatment. You can manage drooling by using bibs or other cloths to absorb excess oral secretion. Additionally, you can use barrier creams around the mouth and chin to help prevent skin irritation.

When Should You Be Worried About Drooling?

Drooling often happens in young children who haven't yet developed the proper motor control or awareness to swallow their saliva. But, by the age of four, children should be able to control their drooling habits. After this age, excessive drooling may be a sign of an underlying condition. If you're unaware that your child has any existing conditions, you should seek additional advice from your doctor.

Excessive drooling usually doesn’t cause serious medical problems, especially if it’s anterior sialorrhea. But if sialorrhea has started to affect your child’s quality of life, it may be worthwhile to seek more advanced treatment from your doctor.

You should also keep in mind that if the onset of sialorrhea is sudden, excessive drooling may be a sign of a throat infection or that your child has swallowed an object.

In all cases, it’s important to take your child to a doctor to get the correct diagnosis and treatment. 

Show Sources

SOURCES:

Archives of Otorhinolaryngology—Head and Neck Surgery: “Botulinum toxin A for treatment of sialorrhea in children: an effective, minimally invasive approach.”

BMJ: “The drooling child.”

Complex Child: “Managing Oral and Respiratory Secretions.”

Journal of Clinical Medicine Research: “Current Aspects of Treatment Options of Chronic Sialorrhea in Children.”

Nationwide Children’s Hospital: “Sialorrhea (Excessive Drooling).”

NHS: “Pneumonia.”

Pediatric Oncall: “Management of sialorrhea in children.”

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