When you have a growing baby, drooling — and possibly drooling a lot — comes with the territory. Drooling tends to appear when babies are around two or three months old — and tends to get worse before it gets better.
“Salivation is very common, especially if your baby is teething,” explains New York pediatrician Dr. Cherilyn Cecchini. In fact, in a study of 254 infants published in the journal BMC Oral Health, drooling was the most frequent teething symptom reported.
“You’ll probably see an increase in drooling when your baby is around five or six months old, after introducing soft foods into their diet,” she says. “Excess saliva makes it easier for babies to swallow soft foods and also contains an enzyme that helps break down food.”
While drooling is completely normal at certain points in your baby’s development, there will come a time when it’s no longer “cool to drool.” To further explain the science of drooling and provide guidance for concerned parents and caregivers, here are insights on what it means if your baby is drooling frequently from pediatricians and pediatric dentists.
Why might your baby be drooling a lot?
According to the experts we spoke to, there are several reasons why all babies drool. Generally, drooling is caused by:
- Increased production of saliva when teething or eating
- Inability to keep saliva in the mouth
- Swallowing problems
“The primary function of saliva is to aid in digestion,” explains Dr. Leah A. Alexander, a pediatrician based in New Jersey. Saliva, he says, contains amylase, an enzyme that breaks down sugars and starches.
By the time your baby is about six months old, their salivary amylase levels reach close to adult levels — allowing them to digest starches for the first time. If you think about it, this timing makes sense and ties in with the American Academy of Pediatrics recommendation for introducing solid foods.
“After your baby’s teeth start coming in, the moisture in the saliva helps reduce bacteria from entering the mouth and affecting the teeth and gums,” added Dr. Alexander in reference to recent research published in the journal Molecular Diagnosis and Therapy. This means that the drool that wets your shoulder actually plays an important role in reducing your baby’s risk for cavities and periodontal disease in the future.
Keeping saliva in your baby’s mouth, according to research in the British Journal of Medical Practitioners, also requires head, neck and mouth muscle control — all of which develop over time. For example, babies usually gain control and balance in their head and neck around 4 months of age and the ability to control when they swallow between 18 and 24 months.
As simple as it may seem to us as healthy adults, swallowing is actually a very complex action involving more than 20 different muscles of the mouth and throat. Problems with or slow development of any of those muscles can result in excessive drooling.
If your baby or toddler has a fever, congestion, poor appetite and/or fewer wet diapers while drooling frequently, Dr. Alexander to call your pediatrician; increased salivation may mean they have an infection.
Does drooling a lot cause hives?
The excess saliva that babies spit out can sometimes irritate the skin around the mouth, as well as on the cheeks, chin, neck or chest. It is often called teething rash, but it can occur regardless of the pending eruption of a new tooth and can be confused with other conditions common in infants such as eczema and hand, foot, and mouth disease.
“Sometimes, drooling can cause dry and peeling skin,” says Dr. Cecchini. “Barrier creams such as petroleum jelly can be used to help soothe and further prevent irritation.”
For example, during a recent trip to Mexico, Dr. Dan Munteanu, a practicing dentist and Director of Blanc Dental Centers in Montreal, Canada, whose one-year-old son developed hand, foot, and mouth disease. “It’s easy to tell the difference in the rashes that babies develop from excessive drooling,” he explains. “A rash from drooling will be distinctive around the mouth, while hand, foot, and mouth sores often have red spots and blisters on the extremities (palms, fingers, hands and feet), as well as too.”
Therefore, if the rash is only around the mouth, it is most likely the result of salivation and not another cause for concern.
If your baby is drooling a lot, when should you worry?
“Parents can worry about many things that are considered normal for their children, and drooling is often one of them,” says Dr. Michael Koumaras, a pediatric dentist in Philadelphia. “I’d rather a child has too much saliva than not enough.”
However, it helps to have a guide. The Thomas-Stonell and Greenberg Scale for Drooling, first published in 1988 in the journal Dysphagia, is still considered a quick and easy assessment tool for parents and providers. It focuses on how much drooling interferes with general activities of daily living and quality of life.
If the drooling is “severe” or “profuse” in severity, Dr. Stop unhealthy sucking habits like using a pacifier or finger sucking. “This will help their mouth grow more naturally and for their lips to seal,” she said. “Parents can also stimulate the oral cavity by introducing raw vegetables or chewy foods and encouraging the use of straws.”
What to do if your baby is drooling a lot
To help your baby become more aware of saliva and mouth movements, play games to imitate facial expressions, recommend researchers in the journals Developmental Medicine and Child Neurology. This can be done in front of a mirror to provide additional visual cues for your baby. Once they reach toddlerhood, you can introduce simple mouth motor exercises, such as blowing bubbles or using a straw to blow feathers, to strengthen the lip and cheek muscles.
If after age two, your baby is still drooling, be sure to bring your concerns to their pediatrician. “Depending on the level of the issues, a speech language pathologist, pediatric neurologist or pediatric oral surgeon can help make sure there’s nothing more serious leading to excessive drooling and recommend treatment options,” says Dr. Coumaras.
Children with special health care needs that affect motor control of the mouth and throat, for example, also have difficulty controlling their saliva. These conditions can include cerebral palsy, pediatric stroke, traumatic brain injuries, autism spectrum disorder and various genetic disorders. Treatment options are based on severity and can range from oral motor training and therapy to medications and surgical procedures.
While teething can increase your baby’s drool game, it’s not the only reason. Those developmental milestones, your little explorer’s oral adventures and the grand introduction to solid foods are all part of the drool scene. As you continue on your parenting journey, stay informed, pay close attention to your baby’s cues and, when in doubt, contact your pediatrician.
