Is Excessive 'Paglalaway' a Sign of Autism?

The first few months of a child's life are most especially magical because it happens so fast! It is also a period of firsts: first smile, first time to crawl, the first adorable spit bubbles — and therefore, first of many wet kisses, and so on.

As the months pass by, however, many parents start to become alarmed when this particular activity seems to become excessive. Yes, hypersalivation, or "sobrang paglalaway" in Filipino, is not only messy, but it might also be the effect of a number of health issues.

What is hypersalivation?

Hypersalivation, also called sialorrhea or ptyalism, occurs when there is an increased production of saliva or decreased clearance of saliva in the mouth.

According to Dr. Mark Reysio-Cruz, a developmental pediatrician, hypersalivation is normal during infancy or the first two years of life. "This is the time when infants do not have full control of the muscles of the mouth and swallowing." 

Causes of hypersalivation or excessive drooling

Among adults, the causes of hypersalivation can include non-infectious causes such as pregnancy, acid reflux, a nutritional deficiency, or it could be a side effect of some medications, among others. An infection triggered by rabies, abscesses, and the like are also possible causes.

On the other hand, hypersalivation could also happen when there is a decreased saliva clearance, which may be due to neurological conditions leading to problems with swallowing, infections, anatomic problems (jaw dislocation/fracture, malocclusion), among others.

Babies don't produce saliva until they are a few months old. "Their purely liquid diet is easy to swallow and mother’s milk doesn’t have starch in it, so babies don’t even need some of the digestive properties of saliva. Drool develops just when the baby needs it," which is around 3 months old, says Dr. Wendy Hunter, a pediatrician at Children's Primary Care Medical Group in California.

Hypersalivation in babies occurs mostly when they've learned to put their hands in their mouth, which stimulates the sensors in the mouth to produce saliva. Moreover, their sense of smell and taste could trigger an overproduction of the fluid.

Is excessive salivation or drooling a sign of autism?

Dr. Reysio-Cruz clarifies that drooling is NOT part of the criteria for diagnosing autism spectrum disorder. However, he says, "[Drooling] may be seen in individuals with autism because of the presence of low muscle tone (hypotonia) around the mouth area and may be also related to the sensory processing disorders that these individuals have."

According to Autism Speaks, "It’s common for children with developmental disorders to drool excessively and for longer than is typical with other children. This includes children with autism, many of whom have delays and difficulties with muscle control and sensitivity."

What to do if your child hypersalivates

As pointed out by Dr. Reysio-Cruz, excessive drooling is to be expected of babies up to two years  of age. However, if it continues and becomes problematic in the older years, accompanied by other symptoms, it is best to have your child evaluated by a specialist, who might recommend therapy or medications as necessary.