All images in this section are for illustration purposes only. Not actual patients or caregivers.

All images in this section are for illustration purposes only. Not actual patients or caregivers.

Chronic Sialorrhea in Pediatrics

What Is Chronic Sialorrhea in Pediatrics?

  • Sialorrhea is drooling or excessive salivation1
  • It is normal in infants, but usually stops by 15–18 months of age2


  • Cerebral palsy (CP)
  • Traumatic brain injury
  • Epilepsy
  • Congenital abnormality of brain development, such as Down syndrome, autism, Angelman syndrome, or Rett syndrome


  • Hypersalivation (excessive drooling)
  • Skin breakdown around the mouth
  • Infection from the skin breakdown
  • Dehydration or not enough fluids
  • Foul odor
445,000 children under the age of 18 are estimated to suffer
from pediatric sialorrhea in the United States3,4

Impact on Daily Living5-11

Signs, symptoms, and effects of sialorrhea.


  • Embarrassment
  • Social isolation
  • Stigmatization


  • Breathing problems or clogged airways
  • Skin irritation
  • Swallowing or feeding difficulties
  • Dehydration


  1. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician. 2004;69(11):2628-2634. Accessed June 18, 2021.
  2. Fairhurst CB, Cockerill H. Management of drooling in children. Arch Dis Child Educ Pract Ed.  2011;96(1):25-30. doi: 10.1136/adc.2007.129478.
  3. Lakraj AA, Moghimi N, Jabbari B. Sialorrhea: anatomy, pathophysiology and treatment with emphasis on the role of botulinum toxins. Toxins (Basel). 2013;5(5):1010-1031. doi: 10.3390/toxins5051010.
  4. American Academy for Cerebral Palsy and Developmental Medicine. Care pathways: Sialorrhea in cerebral palsy. Updated June 4, 2018. Accessed June 18, 2021.
  5. Kalf JG, Smit AM, Bloem BR, Zwarts MJ, Munneke M. Impact of drooling in Parkinson’s disease. J Neurol. 2007;254(9):1227-1232. doi: 10.1007/s00415-007-0508-9.
  6. Ou R, Guo X, Wei Q, et al. Prevalence and clinical correlates of drooling in Parkinson disease: a study on 518 Chinese patients. Parkinsonism Relat Disord. 2015;21(3):211-215. doi: 10.1016/j.parkreldis.2014.12.004.
  7. Banfi P, Ticozzi N, Lax A, Guidugli GA, Nicolini A. A review of options for treating sialorrhea in amyotrophic lateral sclerosis. Respir Care. 2015;60(3):446-454. doi: 10.4187/respcare.02856.
  8. Leibner J, Ramjit A, Sedig L, et al. The impact of and the factors associated with drooling in Parkinson’s disease. Parkinsonism Relat Disord. 2010;16(7):475-477. doi: 10.1016/j.parkreldis.2009.12.003.
  9. Schririnzi T, Imbriani P, D’Elia A, Di Lazzaro G, Mercuri NB, Pisani A. Rotigotine may control drooling in patients with Parkinson’s Disease: Preliminary findings. Clin Neurol Neurosurg. 2017;156:63-65. doi: 10.1016/j.clineuro.2017.03.012.
  10. El-Hakim H, Richards S, Thevasagayam MS. Major salivary duct clipping for control problems in developmentally challenged children. Arch Otolaryngol Head Neck Surg. 2008;134(5):470-474. doi: 10.1001/archotol.134.5.470.
  11. Damian A, Adler CH, Hentz JG, et al. Autonomic function, as self-reported on the SCOPA-autonomic questionnaire, is normal in essential tremor but not in Parkinson’s disease. Parkinsonism Relat Disord. 2012;18(10):1089-1093. doi: 10.1016/j.parkreldis.2012.06.008.