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 probably get worse before it gets better.
Drooling, also known as dribbling, is very common, especially if your infant is teething. In fact, in a study of 254 infants published in the journal BMC Oral Health, drooling was the most frequent teething symptom reported. The NHS offers lots of advice in a special section on teething on their website. And the earlier teething starts, the earlier the drool-fest begins.
You’ll probably see drooling increase even more when your baby is around five or six months old, after soft foods are introduced into their diet. The extra saliva makes it easier for babies to swallow soft foods and also contains an enzyme that helps break down their 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 carers, here are insights from paediatricians and paediatric dentists on what it means if your baby is drooling a lot.
Why might your baby be drooling a lot?
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, as this BBC article explains. Saliva 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 NHS recommendation for introducing solid foods.
Once your baby’s teeth start coming in, the moisture provided by saliva helps prevent bacteria from entering the mouth and affecting the teeth and gums, as shown by 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 of 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 at around four 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 nappies while drooling a lot, then do seek prompt medical advice – in these cases, 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.
The rash from hand, foot and mouth disease is usually quite easy to differentiate from the rash babies develop from excessive drooling. 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.
Drooling can sometimes cause dry and peeling skin. Barrier creams like petroleum jelly can be used to help calm and further prevent the irritation.
If your baby is drooling a lot, when should you worry?
Parents frequently worry about things that experts consider normal, and drooling is often one of them. On the whole, paediatric dentists consider it better to 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 in 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, try stopping non-nutritive sucking habits like using a dummy or sucking fingers. This will help their mouth grow more naturally and allow their lips to close properly. You can also stimulate your child’s oral cavity by introducing raw vegetables or chewy foods and by 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 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 your toddler is still drooling after the age of two, be sure to take your concerns to their GP. Depending on the degree of drooling, they might refer you to a speech and language therapist, paediatric neurologist or paediatric oral surgeon. These specialists will help ensure there is nothing more serious leading to excessive drooling and recommend treatment options.
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, paediatric 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 medication and surgical procedures.
While teething might amp up your baby’s drool game, it’s not the only possible cause. 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, ask your GP or health visitor for advice.
