When you have a growing baby, drooling — and possibly drooling a lot — comes with the territory. Drooling tends to appear when babies are about two or three months old — and will likely get worse before it gets better.
“Drooling is very common, especially if your infant 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 likely see drooling increase when your baby is around five or six months old, after soft foods are introduced into their diet,” she says. “The extra saliva makes it easier for babies to swallow soft foods and also contains an enzyme that helps break down the food.”
While drooling is completely normal at certain points in your baby’s development, there comes 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 a lot from pediatricians and pediatric dentists.
Why might your baby be drooling a lot?
According to the experts we spoke to, there are a few reasons why all babies drool. Generally, drooling is caused by:
- Increased saliva production when teething or eating
- Inability to keep saliva in the mouth
- Problems with swallowing
“The primary function of saliva is to assist with digestion,” explains Dr. Leah A. Alexander, a New Jersey-based pediatrician. Saliva, she says, contains amylase, an enzyme that breaks down sugars and starches.
By the time your baby is about six months old, their levels of salivary amylase reach near adult levels — allowing them to digest starches for the first time. When you think about it, this timing makes sense and correlates with the American Academy of Pediatrics recommendation for introducing solid foods.
“After your baby’s teeth start coming in, the saliva moisture helps reduce bacteria from entering the mouth and affecting the teeth and gums,” Dr. Alexander adds in reference to recent research published in the journal Molecular Diagnosis and Therapy. This means that the drool drenching your shoulder actually plays an important role in reducing your baby’s risk for cavities and periodontal diseases 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 typically gain control and balance in their head and neck around 4 months old and the ability to control when they swallow between 18 and 24 months.
As simple as it might seem to us as healthy adults, swallowing is actually a very complex action that involves over 20 different muscles of the mouth and throat. Problems with or slow development of any one of those muscles can result in excess drooling.
If your infant or toddler has a fever, congestion, poor appetite and/or fewer wet diapers while drooling a lot, Dr. Alexander recommends calling your pediatrician; increased drooling may mean they have an infection.
Does drooling a lot cause a rash?
The excess saliva that babies drool can sometimes irritate the skin around the mouth, as well as the cheeks, chin, neck or chest. This is often called a teething rash, but it can occur regardless of the pending eruption of a new tooth and can be confused with other conditions common in babies such as eczema and hand, foot, and mouth disease.
“Sometimes, drooling can cause dry and peeling skin,” says Dr. Cecchini. “Barrier creams like petroleum jelly can be used to help calm and further prevent the irritation.”
When on a recent trip to Mexico, for example, Dr. Dan Munteanu, a practicing dentist and Director of Blanc Dental Centers in Montreal, Canada, says his one-year-old son caught hand, foot, and mouth disease. “It’s quite easy to differentiate from the rash babies develop from excessively drooling,” he explains. “The rash from drooling will be uniquely around the mouth, whereas hand, foot, and mouth disease often has red spots and blisters on the extremities (palms, fingers, hands and toes), as well.”
Therefore, if the rash is only around the mouth, it’s probably the result of drooling and not another cause for concern.
If your baby is drooling a lot, when should you worry?
“Parents can be concerned 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 have too much drool than not enough.”
Nevertheless, it’s helpful to have a guide. The Thomas-Stonell and Greenberg Scale for Drooling, first published 1988 in the journal Dysphagia, is still regarded as a quick and easy assessment tool for parents and providers. It focuses on how disruptive drooling is on general activities of daily living and quality of life.
If drooling is “severe” or “profuse” in severity, Dr. Koumaras recommends stopping non-nutritive sucking habits like using a pacifier or sucking fingers. “This will help their mouth grow more naturally and for their lips to seal,” he says. “Parents can also stimulate the oral cavity by introducing raw vegetables or chewy foods and encourage the use of straws.”
What to do if your baby is drooling a lot
To help your baby be more aware of saliva and oral movements, play games to imitate facial expressions, recommend researchers in the journal 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 oral motor exercises, such as blowing bubbles or using a straw to blow a feather, to strengthen lip and cheek muscles.
If after the age of two, your toddler is still drooling, be sure to bring your concerns to their pediatrician. “Depending on the degree of issues, a speech language pathologist, pediatric neurologist or pediatric oral surgeon could help ensure there is nothing more serious leading to excessive drooling and recommend treatment options,” says Dr. Koumaras.
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 may 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 might amp up 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 in the know, keep a keen eye on your baby’s cues and, when in doubt, reach out to your pediatrician.
