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

Chronic Sialorrhea in Pediatrics

Two Principal Types1

  • Anterior sialorrhea: forward spillage of saliva from the mouth
  • Posterior sialorrhea: backward spillage of saliva from mouth down airway


  • Cerebral palsy (CP)
  • Traumatic brain injury
  • Epilepsy
  • Congenital abnormality of brain development


  • Excessive wetness
  • Skin breakdown around the mouth
  • Infection from skin breakdown
  • Dehydration or not enough fluids
  • Foul odor
An estimated 445,000 children under the
age of 18 suffer from chronic sialorrhea1,4


Interior effects

  • Risk of breathing problems
  • Swallowing or feeding difficulties

Exterior effects

  • Greater risk of infection
  • Skin irritation
Closeup of chin and neck area in pediatric patient

Impact on Daily Living5-10


  • Embarrassment
  • Social isolation
  • Stigmatization


  • Perioral skin breakdown
  • Aspiration pneumonia
  • Choking
  • Dehydration
Closeup of chin and neck area in pediatric patient

Emma’s Story*: How XEOMIN Treatment Helped Me

“Chronic sialorrhea is really challenging, from skin irritation to trying to guide Emma on how to manage it. Since we started her on XEOMIN, I feel less anxious about Emma’s condition and can more fully enjoy our time together taking our dog, Bandit, to the park or watching Emma play dolls with her friends.”
—Vivian, mother of Emma, a pediatric patient with
chronic sialorrhea treated with XEOMIN*

Individual results may vary.

Emma, a pediatric patient with chronic sialorrhea on XEOMIN®.

*Images and fictionalized story are for illustration purposes only.
Not an actual patient.

Emma was a happy baby—always smiling and wanting to be the center of attention. When she was born, her mom, Vivian, was excited to be a new parent to such a sweet and healthy little girl.

Throughout the first year of Emma’s life, Vivian noticed Emma wasn’t like other babies. Emma never learned to crawl or stand. By the age of 1, Emma was diagnosed with cerebral palsy.

Overwhelmed with fear about the challenges her daughter would face, Vivian enrolled Emma in a specialized rehabilitation center. As she got older and finished teething, Vivian noticed Emma continued to drool—her clothing, bibs, and bedding were always wet. When Emma was 2½ half years old, Vivian asked Emma’s pediatrician about ways to help her manage her daughter’s drooling.

At the age of 3, Emma started receiving treatment for chronic sialorrhea. At first, Emma’s doctors tried acupuncture and oro-motor therapy. As time passed, Emma showed little sign of improvement. Vivian was worried that her daughter’s drooling could lead to other health issues. Vivian refused to sit back and watch—she was determined to find an answer and read everything she could to find the best care for Emma.

“Now that I’ve found XEOMIN, it’s brought me a sense of hope,” Vivian says. “I was always worried about keeping her safe from a lung infection or constantly having to wipe her face so she wouldn’t get a rash. But after we started her on XEOMIN, I saw a real reduction in the amount of saliva, and I could tell it was working.”

For Vivian, XEOMIN was able to provide the peace of mind so Emma can be free to grow up around her peers without her mom constantly worrying that she wouldn’t always be able to be there to take care of her daughter.

Every patient’s experience with XEOMIN will vary, and there are potential risks and side effects with XEOMIN. Talk to your healthcare provider to see if XEOMIN is right for your child.

Emma is an energetic, confident, and fun-loving 6-year-old. When Vivian thinks about Emma’s experiences as she’s getting older, she’s reminded how treatment with XEOMIN has made a big difference for her daughter. “Emma’s been through so much,” she says, “but you would never know it when you look at her. She’s just a big ball of energy.”*

Jacob’s Story*: How XEOMIN Treatment Helped Me

“We needed a more targeted therapy that was effective, and that’s exactly what we got with XEOMIN. Now I get to watch my son grow up around his friends and be a teenager. He’s finally confident to go out in public without worrying about people staring at him.”
—Paul, father of Jacob, an adolescent patient treated with XEOMIN
for chronic sialorrhea*

Individual results may vary.

Jacob, a pediatric patient with chronic sialorrhea on XEOMIN®.

*Images and fictionalized story are for illustration purposes only.
Not an actual patient.

At birth, Jacob was diagnosed with a heart defect, and within hours, he had emergency surgery to treat his condition. Jacob’s father, Paul, was terrified for his son, but after the successful surgery and a few months in the NICU, he was relieved when his son was finally ready to go home.

Paul started noticing developmental challenges with Jacob. When Jacob was 10 months old, he crawled with one arm and one leg while dragging his other arm and leg behind him. Paul mentioned this to Jacob’s pediatrician, who ran a series of tests, and based on those test results, diagnosed Jacob with cerebral palsy.

After Jacob’s diagnosis, Paul noticed that his son drooled more than other kids his age. When it didn’t get better and began causing skin problems, Paul asked Jacob’s doctors for help. Paul was told chronic sialorrhea is a common problem for kids with cerebral palsy. Jacob’s doctors immediately started treating Jacob with oro-sensory therapy. The treatment was successful at managing Jacob’s drooling, but as he became a teenager, things started to get complicated.

“When Jacob started high school," Paul says, "he was embarrassed to be around his friends, and because of his drooling, he stopped hanging out with them. No teenager wants to wear a bib or have their parent wiping their face all the time. I wanted him to live his life without always having to deal with embarrassment that can cause low self-esteem and social anxiety.”

Paul wanted to give his son independence, so he again asked Jacob’s doctors about other treatment options for chronic sialorrhea. After his 14th birthday, Jacob began treatment with XEOMIN. XEOMIN has made a real difference in Jacob’s life—helping him control excess drooling, which gives him the confidence to be himself.

Every patient’s experience with XEOMIN will vary, and there are potential risks and side effects with XEOMIN. Talk to your healthcare provider to see if XEOMIN is right for your child.

Jacob is your average teenage boy, obsessed with sports and the outdoors. He loves watching sports with his dad and inviting friends over to play basketball or go camping in the backyard. When Paul thinks about all the things Jacob has had to overcome in his life, he feels thankful for the quality time he now has with his son. “Our favorite thing to do together is watch basketball games,” Paul says. “I’m just happy he’s not embarrassed by his dad. Yet.”*

*Images and fictionalized story are for illustration purposes only. Not an actual patient.


  1. 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.
  2. 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.
  3. Hockstein NG, Samadi DS, Gendron K, Handler SD. Sialorrhea: a management challenge. Am Fam Physician. 2004;69(11):2628-2634.
  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. 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.
  7. 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.
  8. 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.
  9. 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.
  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.