Clinical Evaluation and Investigations of Drooling in Children

Drooling, or sialorrhoea, is the involuntary spillage of saliva from the mouth or its pooling in the oropharynx. It is common in infants and toddlers and typically resolves by 15–18 months of age, although it is not uncommon to persist util the age of 6–7. Chronic or persistent drooling is particularly common in children with neurodevelopmental disabilities, neuromuscular disease, and genetic syndromes. Drooling can be anterior with significant impact mainly to social interactions and hygiene, or posterior which poses risks of aspiration, respiratory complications, and life-threatening morbidity. In most cases, paediatric drooling is not caused by excessive saliva production but by impaired oral-motor control, reduced swallowing frequency, poor posture or underlying neurological dysfunction. A comprehensive clinical assessment is essential, including a detailed history, physical examination, and impact evaluation using structured tools like the Drooling Severity and Frequency Scale (DSFS) or Drooling Impact Scale (DIS). Instrumental diagnostics, such as videofluoroscopic swallow study (VFSS), flexible endoscopic evaluation of swallowing (FEES), and radionuclide salivagram, are used to assess swallowing function and secretion management mainly when aspiration risk is suspected. Additional investigations, including ENT, dental, craniofacial, and neurological assessments, may be necessary to identify underlying causes. Management involves a stepwise, multidisciplinary approach tailored to the child’s needs. ​ Shared decision-making with families and regular follow-ups are crucial to ensure effective and safe care. ​ Further research is needed to standardise assessment protocols and optimise long-term management strategies.