Drooling (Pediatric)

What is drooling?

Drooling is when saliva pools in the mouth due to tightness, weakness, or poor coordination in the muscles required for swallowing. Drooling can also stem from oral sensory dysfunction and poor head control. Excessive drooling affects children with nerve and/or muscle problems associated with cerebral palsy and other conditions.

Drooling causes discomfort, skin rashes, and embarrassment for children as well as difficulty socializing.

Medical consequences of excessive drooling with poor swallowing are choking, diminished ability to cough and other signs of respiratory dysfunction, and pulmonary infections. One of the most serious concerns is aspiration, where liquid enters the trachea (breathing tube) and leads to pneumonia, frequent hospitalization, and further complications.

Drooling is demanding on relatives and caregiver, requiring frequent suction or wiping of a child’s mouth, changing of bibs and clothing, and constant cleaning of objects in the home.

How is drooling diagnosed?

The first step is to rule out other possible causes of excessive drooling such as gastro-esopahgeal reflux disease, infection, certain medications, and oral stimulation. If drooling does not stop, we proceed with therapy to strengthen muscles, improve coordination and sensation, and make swallowing easier.

What is the treatment for drooling?

Oral medications can be helpful in decreasing saliva production. However, they can have significant side effects such as constipation, difficulty urinating headache, or vision problems—already a challenge for many affected children.

Drooling is also treated with botulinum toxin injections into the salivary glands. This safe and minimally invasive approach uses a tiny needle to place a small amount of botulinum toxin in two to four of the salivary glands. All injections are done under ultrasound and nerve stimulator guidance to ensure correct placement and maximal results. The procedure can be done with or without sedation.

Our pediatric physiatrists are experienced in administering injections and have a high success rate. We see a significant improvement in quality of life and a reduction in hospital admissions with this approach.