Excessive drooling in children (sialorrhea)

What is excessive drooling?

Children can usually control drooling by four years of age. Longstanding excessive drooling (sialorrhea) is a common issue in children with neurological impairment, such as cerebral palsy. Drooling occurs when saliva is not swallowed and flows out of the mouth. This usually occurs from inefficient or infrequent swallowing.

Signs and symptoms of excessive drooling

Excessive drooling is shown by saliva slipping out the side of your child's mouth. It may dribble down their chin. Drooling can irritate the skin of the face, neck and chest. In some extreme cases, drooling can be associated with aspiration pneumonia if saliva pools at the back of the throat and then enters the airways.

Causes of excessive drooling

Excessive drooling is usually caused by poor swallowing. It may be linked with poor mouth and tongue control and is more commonly seen in conditions that affect a child’s neurodevelopment or the nerves that control swallowing. Excessive drooling is not usually caused by too much saliva production.

What your health-care team can do to help

After an initial assessment, your child's health-care team may consult therapists with expertise in swallowing, such as occupational therapists or speech-language pathologists. Other specialists that may be helpful in managing sialorrhea include otolaryngologists (ear, nose and throat specialists), neurologists, dietitians and pharmacists. Some children may be referred to an interventional radiologist.

Depending on your child's condition, their health-care team may recommend treatment to reduce the risk of aspiration pneumonia.

Treatment for excessive drooling

Non-surgical treatments may include:

• reducing the volume of fluids that a child receives
• medicines, such as atropine or glycopyrrolate to help reduce the amount of saliva produced
• Botox injections into the salivary glands under general anaesthetic by an interventional radiologist

Rarely, surgery targeting the salivary glands or salivary ducts may be recommended.