Babies salivating: Drooling and Your Baby – HealthyChildren.org
My Teen Has Excessive Saliva… Should I Worry?
By PatientConnect365
Parents tend to have an intimate relationship with drool. After all, since infants seem to have absolutely no idea what to do with all that saliva in their mouths, they tend to just let it drip out … all over your arm, your shoulder, your relatives, and the floor.
Thankfully, this type of drooling doesn’t last very long, abating around the time your toddler’s teeth start to arrive. However, when excess saliva and drooling appears in an older child, you may wish to dig a little deeper to find the root cause.
Generally speaking, excess saliva production, or simply, hyper-salivation, is not a common indicator of a serious illness. It can, however, be an annoying accompaniment to daily living, and if you have a teen suffering from the malady, they may press you for help to find a solution to avoid any undue social stress.
There a few common causes for hyper-salivation, so let’s take a look at the top five:
- GERD: Acid reflux disease creates more saliva in an attempt to combat the acid that flows from the stomach upwards to the esophagus. This is, by far, the most common reason for increased saliva among adults, but it can also affect teenagers, and is frequently the cause of drooling in toddlers. Teenagers are certainly not immune to GERD, and these days, physicians are seeing it appear in younger populations due to a greater consumption of beverages that contain citric acid like energy drinks, sports drinks, and soda.
- Poorly-Fitted Orthodontics: An ill-fitting retainer, or a braces bracket that is off-kilter can interfere with proper swallowing and prohibit the timely swallowing of saliva. Likewise, if your child has undergone orthodontic work, but does not currently wear a retainer, even the placement of their teeth can create issues with proper swallowing.
Check with your orthodontist, or dentist can check to see how your child’s bite might be causing issues.
- Certain Medications: Medications, such as clonazepam (Klonopin), clozapine (Clozaril, Fazaclo ODT), pilocarpine (Salagen) and carbidopa-levodopa (Parcopa, Sinemet) can create issues with increased salivation. Are any of these names on your child’s medication list?
- Allergies and Sinusitis: Immune related distress and sinusitis can most certainly trigger hyper-salivation. Speak with your allergist for suggestions or alternative therapies if your child is recently experiencing problems.
- Pregnancy: Hormonal upset, nausea and GERD all combine to create the perfect environment for hyper-salivation. If your teen is pregnant, this could be a contributing factor.
If you have visited with your dentist, doctor, and allergist, and are still unable to pinpoint a reason for your child’s hyper-salivation, you may wish to schedule an appointment with an Ear, Nose and Throat (ENT) physician to explore further possibilities.
In most cases, hyper-salivation is temporary and related to one of the above causes, but if you still don’t have the solution you’re seeking, a visit with an ENT might be a good idea to rule out anything more serious.
Interesting Facts and Figures about Saliva
Most mature salivary glands produce about 600mls per day. Resting or unstimulated whole saliva is produced at a rate of 0.3-0.5ml/minute while stimulated saliva is 1.0-3 ml/minute.
Natural Development of Saliva Control
- Drooling is the unintentional loss of saliva from the mouth and it can give the appearance of excessive saliva production, although this is not always the case. Drooling is considered a normal phenomenon in children before they develop adequate oral neuromuscular (nerve and muscle) control related to positioning, activity, oral muscle functioning, and the integration of these muscle movements. This is achieved about the age of 18-24 months.
- Drooling occurs normally when a child is acquiring a new motor skill, and until the skill becomes automatic, the drooling may continue.
When a child cuts a new tooth, drooling occurs before, during and just after the event.
- Since the production of saliva is related to the digestion of food, infants produce only a small amount of saliva before the age of 3 months as their only diet is cow’s or breast milk. The minimum amount is made for the purpose of keeping the mouth moist and clean. However, as the child grows, glands enlarge and more saliva is produced. As the textured food changes from liquids to semi solids, chewing skill develop. The infant is then required to learn to control the saliva amounts that fill the mouth whilst they are not eating.
Saliva Control Stages of Development
Below illustrates the naturally occurring process of saliva development for the following stages of infancy:
After 3 months, 6 months, 9 months
15 months and 24 months
After 3 months
Infants begin to produce greater amounts of saliva. If lying flat, face up or reclining; gravity will enable the saliva to follow its due course with the swallow. They may drool when:
- a baby initiates head lifting or turning, or when gravity works against the normal path, drooling may occur.
6 months
Infants control their saliva lying face down, on their backs and in supported sitting positions. They may drool when:
- Teething or using their hands for reaching or using objects.
- Beginning to attempt tasks requiring concentration or finer use of their fingers or hands (due to a reduction in mouth control).
- Before, after or during a meal; they produce more saliva .
9 months
Even during larger movements such as rolling, sitting or belly-crawling; drooling is absent. The child will not generally drool around mealtimes.They may drool when:
- Cutting a tooth.
- Eating certain foods.
15 months
Drooling is no longer present when continuously attempting newly acquired advanced movements such as walking. They may drool when:
- Teething.
- Concentrating on advanced fine finger movements like self-feeding, random-play or undressing.
24 months
Children have developed the structure and control of their nerves and muscles to engage in the fine finger movements mentioned above, manipulating small objects and forming two-word speech combinations all without drooling.
Suukool.ee – Laste hammaste tervis
During pregnancy, milk teeth are formed, permanent teeth begin to form only when the child reaches one year of age. Therefore, healthy nutrition of the child is important for the teeth both during pregnancy and after it.
Breast milk is the best food for an infant, and breastfeeding is the best exercise for the bones and muscles of his jaw to develop properly. It is very important that the baby suckle correctly, because incorrect sucking techniques can cause the back position of the lower jaw. Then the so-called. microgenia (micrognathia of the lower jaw), which then has to be treated orthodontically. If your baby is unable to suckle properly, contact a lactation consultant. It will help you figure out what is causing the problem. For example, a child may have a tongue tie that interferes with suckling. nine0003
Newborns do not have bacteria in their mouths that cause holes in their teeth. These bacteria get to the child from loved ones who kiss him on the lips, taste his food or “clean” his nipple in his mouth. If the number of microorganisms that cause holes in the teeth is high in the mouth of the parents, then it is also likely that these microbes will be transmitted to the child. Therefore, it is very important that both the mother and the father have no holes or inflammation in their teeth.
All forms of transmission of germs from adult to child should be avoided – for example, kissing the child on the cheeks, not on the lips, cleaning the pacifier under water instead of sucking it, feeding the child from a baby spoon, and not from the one with which an adult tastes food for temperature and taste, keep their own and children’s toothbrushes separately, etc. nine0003
After the birth of a child, it is important to share information about dental health with relatives whom you will trust your baby. The oral microflora and eating habits are passed on from parents, which means that both hereditary factors and the environment influence the child’s teeth, i.e. habits. It is in developing the right habits that the family plays a large and important role.
Recommendations
→ Bottle nipples should be selected according to the age of the baby. nine0003
→ If the baby sucks his thumb, give him a pacifier or feed him more often. Thumb or thumb sucking can become a hard habit to break and can cause jaw bone deformity.
→ No one should touch the child’s spoon, nipple or rim with their mouth. Keep your child’s toothbrush separate from other family members’ toothbrushes.
→ When introducing complementary foods, do not overdo it with carbohydrates.
→ Do not give sugary drinks in a bottle. nine0003
→ When the child is already teething, make sure that there are pauses between meals. Gradually try to make these pauses longer. Avoid nighttime feedings if possible.
→ Wean a sleeping baby from the breast or take the bottle from him.
→ Give your baby a sip of water after a night feed.
Baby teeth are important for a child’s normal nutrition, for maintaining space for permanent teeth, and for language development. Around the sixth month of life, the lower incisors erupt first, followed soon after by the upper incisors. Eruption continues for the next three years until all 20 milk teeth appear in the mouth. It happens that teeth erupt earlier, then they need to be taken care of immediately. nine0003
Teething can be painful and the baby may refuse the breast or bottle, the gums may become swollen and red, and excessive salivation may occur. Sometimes the temperature also rises. The child may scream more than usual, and parents may have more than one sleepless night. Whether teeth have erupted can be checked by running clean fingers over the baby’s gums – the sharp crowns of the teeth are easily felt.
If a child has not yet erupted a single tooth by the age of one, this may be a cause for concern and a doctor should be consulted. In premature babies, teeth may erupt several months later than usual. nine0003
Teething discomfort relief
To relieve the discomfort and pain associated with teething, you can massage your baby’s gums with clean fingers. If too much saliva is released during teething, the child may develop a rash around the mouth, in which case the saliva can be blotted with a soft cloth. In case of inflammation, a moisturizing protective cream or hygienic lip oil will help.
Teething can be soothed by cool drinks and solid foods. Cold softens inflammation in the gums, so before giving the baby a teething toy, you can cool it in the refrigerator. Chewing on the edge of a clean, cool, and damp cloth can also be soothing. The child can also be offered solid food, such as crackers, a piece of cold apple or cucumber. If sucking is difficult, you can also feed from a cup with a spout. nine0003
During teething, carefully monitor the baby’s behavior and temperature. Sometimes problems that require medical attention (such as otitis media) are mistaken for teething inflammation. If your child has a high fever or very severe pain, see a doctor, because these symptoms are not typical for teething.
6-12 months
Incisors
6-12 months
9-16 months
Bits
13 – 19 months
Molars
13 – 19 months
16 – 23 months
Canines
23 – 33 months
Molars
23 – 33 months
When the first milk teeth have just erupted and are just peeking out of the gums, they should already be cleaned! Newly erupted teeth can be easily cleaned with a soft silicone fingertip toothbrush or clean gauze wrapped around the finger. You can also use a regular brush, but it should be soft and with a small head. nine0003
No toothpaste required at first, but if desired, a special children’s dentifrice gel or toothpaste labeled as suitable for children aged 0 to 3 can be used. The correct dosage is important: the brush only needs to be lubricated with gel or paste.
Teeth brushing technique
Teeth should be brushed twice a day. Brush your baby’s teeth when he is in a good mood, gradually turning this process into a pleasant daily ritual. The baby needs to brush his teeth in a comfortable position for him! nine0076 The child can both lie down and stand. At the same time, you can be both in front and behind – the main thing is that the child is comfortable, and you can see his teeth.
Try making brushing your teeth a game, a fun activity, like singing, talking about teeth and germs. To divert the attention of the child, give him a toy in his hands.
Recommendations
→ Brush your child’s teeth at a time and position that is comfortable for him. nine0003
→ The duration of the procedure does not matter, the main thing is that all surfaces are cleaned and the child likes it.
→ Finger brushes, baby toothbrushes and teething toys should always be thoroughly washed with warm water before use, then wiped or allowed to dry.
→ Children’s oral care should not be kept in a glass with other family members’ toothbrushes.
Salivation – causes, diagnosis and treatment
Salivation (sialorrhea, hypersalivation) is normally observed in infants, pregnant women, and also with mechanical irritation of the receptors of the oral cavity. Common etiological factors are diseases of the gastrointestinal tract, teeth, ENT organs, damage to the central and peripheral nervous system. To diagnose the causes of salivation, saliva is examined, blood and urine tests are performed, instrumental visualization of the gastrointestinal tract and central nervous system. To stop the symptom, it is necessary to cure the underlying disease. Anticholinergics, botulinum toxin preparations are prescribed to reduce salivation. nine0003
Causes of salivation
Physiological factors
The symptom occurs in most women in the first trimester of pregnancy. The appearance of salivation is associated with reflex irritation of the nerve centers that control the production of saliva. The intensity of the manifestations is different: from single nocturnal episodes of sialorrhea to a constant and uncontrolled flow of saliva, when a woman loses up to 3-5 liters of fluid per day. Salivation is the norm in infants, children during the eruption of milk and permanent teeth. nine0003
Mechanical irritation of the oral cavity
Hypersalivation with saliva flowing from the corners of the mouth is a typical problem for people who have begun to wear removable dentures. Within a few months, getting used to a foreign body, and the amount of saliva secreted gradually decreases. Short-term sialorrhea is observed with dental procedures, the use of chewing gum or sucking sweets. Drooling occurs in many smokers.
Dental diseases
Sialorrhoea often develops with stomatitis, gingivitis, carious lesions of the teeth. The symptom is associated with irritation of the M-cholinergic receptors of the mucosa. Salivation is expressed moderately, more often appears at night. During the day, a slight leakage of saliva is possible, which accumulates in the corners of the mouth. In addition to increased salivation, patients complain of soreness and burning in the oral cavity, pain when chewing and swallowing, fetid breath.
Diseases of the gastrointestinal tract
Sialorrhoea is possible with damage to the stomach and the initial sections of the intestine. Its appearance is most typical in chronic pancreatitis, cholecystitis, peptic ulcer. The symptom occurs at any time of the day, often accompanied by heartburn and an unpleasant aftertaste in the mouth. A combination of salivation with abdominal pain syndrome, nausea and vomiting, and stool disorders is characteristic. nine0003
ENT diseases
Salivation is typical for people who suffer from nasal breathing difficulties and sleep with their mouths open. It occurs in patients with sinusitis, chronic rhinitis, in childhood – with adenoids. Salivation develops mainly during sleep. Due to the constant drying of the mucosa, viscous saliva is secreted in a small amount, accumulating on the skin of the perioral zone or leaving marks on bed linen.
Worm infestations
Reproduction of helminths in the gastrointestinal tract causes irritation of peripheral receptors, reflexively activating the secretion of saliva. A specific sign of helminthiases is salivation, which worries at night. A person will recognize the presence of a problem by wet spots on the pillowcase and pajamas. Dried crusts of saliva are visible in the corners of the mouth after waking up. Symptoms are supplemented by pain in the abdomen, dyspeptic disorders, itching in the anal area.
Neurological pathologies
The symptom occurs in pathological processes affecting the centers of regulation of salivation. Drooling is one of the first signs of Parkinson’s disease, a cerebral tumor. In such conditions, saliva is formed in large quantities, it has to be constantly swallowed. Since problems with swallowing later join, saliva begins to drain from the corners of the mouth. nine0003
Salivation can be caused by a violation of the innervation of the facial muscles and the inability to completely close the mouth. The manifestation is pathognomonic for facial paralysis, residual effects of a stroke. Saliva always flows from one side of the mouth, where there is sagging of the muscles of the cheek and insufficient closing of the lips. Salivation increases when a person tilts his head to the side towards the affected side of the face.
In bulbar syndrome, sialorrhea is caused by swallowing problems and the inability to keep saliva in the mouth. The functioning of the salivary glands remains at the same level or even decreases. Patients feel the saliva present in the mouth, but the automatic act of swallowing does not occur. Salivation disturbs constantly, regardless of the time of day. Later, speech disorders, difficulty swallowing solid and liquid food join. nine0003
Complications of pharmacotherapy
Most often, salivation is increased during treatment with M-cholinomimetics. Drugs affect peripheral receptors, stimulate the functions of the salivary glands. In this case, there is a strong uncontrolled salivation, in which saliva flows profusely down the chin. The symptom is determined from the first days of taking medication. There are other drugs that cause salivation:
- Iodine-containing drugs.
- Barbiturates. nine0146
- Benzodiazepine derivatives: nitrazepam, phenazepam.
- Antipsychotics: triftazin, haloperidol, moditen-depot, clopixol.
Rare causes
- Congenital forms of salivation : Glaser syndrome, Cray-Levy syndrome.
- Mental illness : schizophrenia, bipolar disorder, catatonic syndrome.
- Poisoning : organophosphorus substances, metals (lead, mercury), poisonous fungi and plants.
nine0146
- Hormonal disorders : hyperestrogenism, menopause, thyroid disease.
Diagnostics
With the problem of salivation, patients turn to the dentist, less often to the therapist. Given the variety of causes of pathology, the doctor is required to take a detailed history and clarify accompanying complaints. Diagnostic search begins with an examination of the oral cavity to identify signs of an inflammatory process or caries. To establish the causes of salivation, the following instrumental and laboratory diagnostic methods are used:
- Biochemical analysis of saliva. The study evaluates the amount of fatty acid metabolites formed during the life of the bacterial flora. Based on the results of the analysis, it is possible to establish the presence of dysbacteriosis, to determine the level of damage to the digestive tract.
- General clinical studies. Patients with salivation undergo a complete blood count, changes in which indicate the presence of an inflammatory or infectious process.
To exclude helminthic invasions, a coprogram is prescribed, a study of feces for helminth eggs. According to indications, a clinical analysis of urine, studies according to Nechiporenko and Zimnitsky are performed. nine0146
- Instrumental methods. If a patient suffering from salivation has complaints about the work of the digestive system, ultrasound of the abdominal organs, plain radiography is necessary. To exclude neurological diseases, CT or MRI of the brain is recommended. Electroneuromyography is effective for evaluating the functions of peripheral nerves.
Treatment
Help before diagnosis
Moderate salivation is not a health hazard and does not require immediate treatment. With nocturnal sialorrhea, patients are advised to sleep on their side so that saliva does not enter the respiratory tract. To prevent maceration of the skin around the mouth, you need to observe hygiene, use nourishing and moisturizing creams. Since there is a risk of dehydration with excessive salivation, you should increase the amount of fluid you drink per day. nine0003
To reduce saliva production, doctors advise avoiding sweets, carbonated drinks and foods rich in extractives. Hygienic care of the oral cavity is best done with slightly foaming toothpastes. With violations of swallowing and dysfunction of the perioral muscles, motor exercises are prescribed to help control salivation. Less commonly used special massage and physiotherapy.
Conservative therapy
In most situations, salivation can be completely eliminated after treatment of the underlying pathology. The therapeutic regimen is selected by a doctor of the appropriate profile: gastroenterologist, otolaryngologist, neurologist. If salivation is due to acute poisoning, an intensive detoxification program is performed in a hospital. With massive sialorrhea, pathogenetic therapy is required, which includes:
- M-cholinolytics .
Medicines inhibit the secretion of the salivary glands, quickly eliminating salivation. In addition to standard tableted products, there are skin patches. Also use solutions with anticholinergics for rinsing the mouth.
- Tricyclic antidepressants . An additional effect of medications is a decrease in the functional activity of the glandular tissue. They are predominantly prescribed for psychogenic salivation.
nine0145 Botulinum toxin . Botulinum toxin temporarily blocks the nerve impulses that stimulate salivation. It is used in the form of local injections in the absence of the effect of standard conservative treatment.
Surgical treatment
Surgery is recommended for severe neurological causes of salivation if other methods have failed. Surgeons use several types of operations: redirection of the excretory ducts to the back of the mouth, ligation of the ducts, partial removal of the salivary glands.