Drool rash around the mouth: gentle care during teething

Somewhere around the time your baby starts gnawing on everything, the chin often turns red and chapped. Drool rash is one of the most common skin complaints of the first year and a half. It isn’t dangerous, but it can look sore, and it tends to come back every time a new tooth is on the way.

Why babies drool so much

According to the American Academy of Pediatrics (AAP), a baby’s salivary glands kick into high gear around two to three months. The glands are ready, but the muscles for swallowing aren’t fully developed yet, so saliva spills out. Drooling usually carries on until about 18 months.

Teething adds to it. The NHS lists excessive drooling, a rash on the face and one flushed cheek among the common signs of teething, alongside sore red gums, chewing and fussiness. The first baby tooth usually comes at about six months, the Canadian Paediatric Society says, but it can show up anywhere from three to 12 months.

What drool does to the skin

Drool rash is a kind of irritant dermatitis, meaning skin inflammation caused by something irritating the skin rather than by an allergy. The problem isn’t that saliva is harmful. It’s that the skin gets wet, dries, and gets wiped or rubbed, over and over again. Skin that is soaked and dried all day long ends up chapped, a bit like your own lips in a Canadian January.

You’ll usually see it where drool collects:

• on the chin and around the mouth
• on the cheeks, especially the side your baby sleeps or rests on
• in the folds of the neck
• on the upper chest, where a wet shirt sits against skin
• on hands that spend a lot of time in the mouth

The skin looks red, rough or slightly bumpy, and may feel a little raised. It often gets better when drooling eases, then flares again with the next tooth.

Gentle care that helps

The goal is simple: keep the skin as dry as you reasonably can, and give it a shield against the wetness you can’t avoid.

• Pat, don’t rub. The AAP suggests gently wiping your baby’s chin, neck and cheeks through the day. A soft cloth and a light touch are enough; repeated rubbing adds friction.
• Use a soft cotton bib. The AAP recommends a soft, absorbent cotton bib, changed as soon as it gets damp. A soaked bib pressed against the neck is part of the problem.
• Take bibs off for sleep. Bibs come off before naps and nighttime sleep, for breathing safety.
• Wash bibs gently. The AAP suggests a mild, fragrance-free detergent and skipping fabric softeners and stain removers on items that touch the rash.
• Change wet clothing. If the neckline of a shirt is soaked, a fresh one helps.

Using a barrier ointment

A barrier ointment is a thick product that sits on top of the skin and keeps water from reaching it. For drool rash, it works like a raincoat: saliva lands on the ointment instead of the skin. The AAP suggests asking your child’s doctor about a barrier cream or ointment to keep drool from irritating the face.

What to look for:

• Plain and fragrance-free. Petroleum jelly and other simple ointments work well. Fragrance adds nothing on irritated skin.
• An ointment rather than a lotion. Ointments are greasier, but they stay put and repel water better than thin, watery lotions.
• A short ingredient list, especially near the mouth, since some will inevitably end up being licked.

Apply a thin layer to clean, dry skin before naps, bedtime and meals, and whenever the skin looks raw. You don’t need to scrub off the previous layer; just pat away drool and food and reapply. Our list of balms and ointments can help you compare plain options.

Skip numbing teething gels, too. The Canadian Paediatric Society advises against rubbing numbing gels on a child’s gums, because they may be swallowed. For sore gums, it suggests rubbing them with a clean finger or offering a firm rubber teething ring or a cold, wet facecloth.

When it might be something else

A red face in a baby isn’t always drool. A few other conditions show up in the same area and need different care.

• Eczema (atopic dermatitis). The American Academy of Dermatology says babies often develop eczema on the cheeks, forehead or scalp. It’s intensely itchy, so babies rub their faces on sheets and shoulders. On lighter skin, it’s usually a red, bumpy rash that may ooze and crust; on darker skin, it may look like many small bumps, with or without redness, and darker patches. Eczema tends to show up on more than just the drool zone.
• Impetigo. This is a bacterial skin infection. The Canadian Paediatric Society says it usually appears around the mouth and nose, and the blisters may ooze and form a honey-coloured crust. It’s more common on skin that is already irritated, like a drool rash or eczema. It’s contagious and needs a doctor, who may prescribe an antibiotic.
• A rash with fever or illness. Teething doesn’t cause a real fever. The NHS says a teething baby’s temperature may rise slightly but stays below 38 °C, and there’s no evidence teething causes diarrhea.

When to see a doctor

Check in with your doctor, nurse practitioner or pharmacist if:

• the rash isn’t improving after a week or two of gentle care
• the skin is cracked, bleeding or very sore
• your baby seems very itchy, or the rash spreads beyond the mouth and neck
• you see blisters, oozing or honey-coloured crusts
• your baby has a fever; the Canadian Paediatric Society says to call a doctor for any fever in a baby under six months

The AAP also advises calling your paediatrician if heavy drooling comes with fever, trouble swallowing or illness. Call 911 if your child shows signs of choking or trouble breathing.

Drool rash is a normal side effect of a growing baby. Keep the skin dry with gentle pats and a clean cotton bib, protect it with a thin layer of plain ointment, and it usually settles. If the rash looks crusty, itchy or spreads, or if your baby has a fever, let a health professional take a look.