Babies drool. It’s a fact of life for all parents of infants. But there are times when it seems to run like a faucet, leaving clothes and bedding a mess. What’s all that drool about? What causes it and when should you be concerned?
“Drool, or saliva, is important to the digestive process as it serves to moisten food, making it easier to swallow,” says Dr. Kenneth L. Wible, Chief of General Pediatrics at The Children’s Mercy Hospital in Kansas City. “It also contains amylases and lipases, enzymes that initiate the breakdown of nutrients in the food so that they can be absorbed by the body.”
In addition, saliva is a natural lubricant, moistening the esophagus and helping to neutralize acidity. Infants and children, as well as adults, produce saliva as part of the normal course of digestion. However, older children and adults have developed the ability to control their saliva that young infants simply don’t have.
“Infants have not learned to swallow the saliva being produced, so it simply overflows the mouth,” Dr. Wible says. “Salivary output commonly increases sharply at about 4 months of age and some experts see this as a natural sign that the infant is ready to begin digesting solid foods.”
Kelli Estes, a mother of two from Woodinville, Wash., first noticed her youngest son’s excessive drooling when he was about 4 months old. “I’d always thought drooling was a sign of teething, but in this case it wasn’t,” she says. “He would drool so much his shirt would be drenched and I’d have to keep a bib on him all the time.”
Estes finally asked her pediatrician about it and he informed her that the swallowing muscles in her son’s throat had not fully developed yet. “The kid just wasn’t swallowing his spit,” she says. “It resolved on its own a couple months later.”
Young infants have also generally not learned to keep their lips closed and that, quite simply, leaves a “wide open” opportunity for drool to escape.
The most common misconception is that excessive drooling is caused by teething. This is actually a myth as evidenced by the fact that very, very young babies who are not yet cutting teeth still drool.
“[Drooling] is often thought to be a sign of teething,” Dr. Wible says. “This is usually not the case. Although, tooth eruption may increase salivary production.” More likely, your baby is just getting ready for some solid food to be added to his diet.
Drooling also does not cause acid reflux in infants. “Acid reflux into the lower esophagus will stimulate salivary production, even in adults, by a reflex neural mechanism,” Dr. Wible says. “The drooling may actually be a sign rather than a cause of reflux.
Dr. Carol Steltenkamp, associate professor of Pedatrics at the University of Kentucky, agrees. “I am unaware of any studies that correlate excessive drooling with gastroesophageal reflux disease (GERD),” she says. “Babies with true reflux may be spitting up some breast milk or formula as opposed to drool, which is saliva – clear and watery.”
While this may be reassuring, you should always feel free to speak with your pediatrician if you are concerned about the possibility of reflux in your infant.
Drooling doesn’t usually cause too many problems in and of itself. However, all that extra saliva has to go somewhere. Clothing and sheets can become soaked, and where Baby’s delicate skin rubs, for instance their cheeks during sleep, secondary problems can occur, such as rashes or chafing of the skin of the cheeks and chin.
If skin irrigation occurs, Dr. Wible suggests using a moisture barrier on the skin, such as Vaseline, which can provide a degree of protection. “Bibs can be used to protect clothing but we don’t recommend these or other loose materials for the unobserved sleeping infant because they may result in airway obstruction,” he says.
If the above solutions don’t work, he also recommends use of a mild anti-inflammatory cream (0.5 percent hydrocortisone cream), which may be applied very sparingly to the area once daily. “If this is not successful in producing relief of redness and irritation, the infant should be seen [by a pediatrician], as secondary infection can occur due to the skin breakdon,” Dr. Wible says.
As with all medical suggestions, the use of the hydrocortisone cream should be done only with the approval of your own pediatrician.
Sometimes prevention is the best course of action. As mentioned above, bibs are handy during waking hours to keep clothes dry. But other items commonly used by babies, in combination with drooling, can actually create a problem.
“The skin irritation may also be exacerbated by trapping that moisture behind a pacifier,” Dr. Steltenkamp says. “Pacifiers are OK to use but just be cognizant of this potential. Parents can best handle these problems by keeping the skin around the mouth dry – wipe it off.” Keeping a dry cloth handy at all times should make that job easier. A few extra dry bibs might be useful, too.
Serena Robar, a mother of three from Maple Valley, Wash., found a way to help the drooling problem. “I would let my baby chew a dry washcloth,” she says. “It would help sooth the gums, help incoming teeth break through and soak up the excess drool.”
Another thing Dr. Wible suggests keeping in mind is that common remedies for teething discomfort, such as rings and pacifiers, may stimulate increased salivary production.
“The important thing to remember is that this is a natural process that, with the exception of skin irritation, does not produce any medical complications in the healthy infant,” Dr. Wible says.