Facts about newborns gagging in their sleep

Drooling caused by nervous system problems can often be managed with drugs that reduce saliva production. Different drops, patches, pills or liquid medicines may be tried.

Drooling

Drooling, or excessive salivation, in infants and toddlers is normal and is highly unlikely to be associated with either disease or complications.

Considerations

• Problems keeping saliva in the mouth
• Problems with swallowing
• Too much saliva production

Some people with drooling problems are at increased risk of breathing saliva, food, or fluids into the lungs. This may cause harm if there is a problem with the body’s normal reflexes (such as gagging and coughing).

Causes

Some drooling in infants and toddlers is normal. It may occur with teething. Drooling in infants and young children may get worse with colds and allergies.

Drooling may happen if your body makes too much saliva. Infections can cause this, including:

• Mononucleosis
• Peritonsillar abscess
• Strep throat
• Sinus infections
• Tonsillitis

Other conditions that can cause too much saliva are:

• Allergies
• Heartburn or GERD (gastroesophageal reflux disease)
• Poisoning (especially by pesticides)
• Pregnancy (may be due to pregnancy side effects, such as nausea or reflux)
• Reaction to snake or insect venom
• Swollen adenoids
• Use of certain medicines

Drooling may also be caused by nervous system disorders that make it hard to swallow. Examples are:

• Amyotrophic lateral sclerosis, or ALS
• Autism
• Cerebral palsy (CP)
• Down syndrome
• Multiple sclerosis
• Parkinson disease
• Stroke

Home Care

Popsicles or other cold objects (such as frozen bagels) may be helpful for young children who are drooling while teething. Take care to avoid choking when a child uses any of these objects.

For those with chronic drooling:

• Caregivers may try reminding the person to keep their lips closed and chin up.
• Limit sugary foods, because they may increase the amount of saliva.
• Watch for skin breakdown around the lips and on the chin.

When to Contact a Medical Professional

Contact your health care provider if:

• The cause of the drooling has not been diagnosed.
• There is concern about gagging or choking.
• A child has a fever, difficulty breathing, or holds their head in a strange position.

What to Expect at Your Office Visit

Your provider will do a physical exam and ask questions about your symptoms and medical history.

Testing depends on a person’s overall health and other symptoms.

A speech therapist can determine if the drooling increases the risk of breathing in food or fluids into the lungs. This is called aspiration. A speech therapist may provide information about:

• How to hold your head
• Lip and mouth exercises
• How to encourage you to swallow more often

Drooling caused by nervous system problems can often be managed with drugs that reduce saliva production. Different drops, patches, pills or liquid medicines may be tried.

If you have severe drooling, the provider may recommend:

• Botulinum toxin (Botox) shots
• Radiation to the salivary glands
• Surgery to remove the salivary glands

References

Nicholson AM, Hess JM. Esophagus, stomach, and duodenum. In: Walls RM, ed. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 75.

Ostrem JL, Okun MS. Parkinsonism. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 378.

Slavotinek AM. Dysmorphology. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 128.

Weiss AK, Balamuth FB. Triage of the acutely ill child. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 80.

Version Info

Last reviewed on: 10/13/2023

Reviewed by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Facts about newborns gagging in their sleep

Making sure your baby is safe is the most important job as a parent, so it may concern you when your baby spits up or gags. Learn the difference between spitting up and vomiting, gagging, and choking in babies so you better understand when yours needs help.

Written by
Megan N. Freeland, PharmD
Content Writer
Medically reviewed by
Dr. Marcy Borieux
Pediatrician

Choking is a medical emergency. If your baby is choking, start baby CPR and call 911.

Do babies have a gag reflex?

The gag reflex is activated when any object — like a finger, food, or a spoon — touches a sensitive area in the back of the throat. Stimulation of this area leads to an automatic muscle contraction that pushes the object in the opposite direction, out of the mouth. In this way, the gag reflex is protective and can help prevent choking.

Babies usually have a strong gag reflex through about 6 months of age, around the time when they start solids. Some babies have a more sensitive gag reflex and may gag more often.

Gagging vs. choking: how do I know the difference?

Gagging is not the same as choking. If your baby is gagging, they may:

• Be noisy, or make coughing, gargling, or other sounds
• Spit up or vomit
• Thrust their tongue forward

If your baby is gagging, it’s important to let their body get rid of the object on its own. Do not place your fingers or any other object in your baby’s mouth to try to remove what they are gagging on. You may accidentally push the object further into their throat.

Choking is a quiet emergency. Choking happens when your baby’s airway is partially or completely blocked. Therefore, air cannot get through and your baby may not be able to breathe.

Signs your baby is choking include:

• Quietness
• Inability to cough or cry, or an attempt to make these sounds unsuccessfully (A partial cough means at least some air is able to get through and this is likely a partial blockage.)
• Face or lips turning blue or purple
• Struggling to breathe

If your baby is choking, perform baby CPR right away and call 911. Ensure you’re prepared for this type of emergency ahead of time by taking a baby CPR class from the American Heart Association or the American Red Cross. The American Red Cross also provides a general overview of how to perform infant choking CPR.

Can an infant choke on vomit or spit?

According to the American Academy of Pediatrics (AAP), the risk of a baby choking on their own spit or vomit is low, in part due to their gag reflex. It’s helpful to ensure you and any of your baby’s caregivers are trained in baby CPR.

Why does my newborn gag during sleep?

Newborns may gag in their sleep due to:

• Saliva: It’s normal for babies to cough or gag on their spit from time to time.
• Being sick: When your baby is sick, they may have thicker mucus or spit than normal, which may make them gag in their sleep.
• Reflux: Babies with reflux may spit up more often, which can lead to gagging or coughing.

Keeping your baby upright for about 30 minutes after feeding can help reduce reflux symptoms and make them less prone to spit up and gag during sleep.

What if my newborn spits up while sleeping?

All babies have reflux or “spit up” at some point. This is known as gastroesophageal reflux (GER) and is common in babies under 2 years old. Gastroesophageal reflux disease (GERD) is a more long-term, serious condition where reflux leads to continued symptoms or complications.

A baby’s gag reflex is triggered by spit up or vomit, which causes them to spit it out or swallow it. Research shows that the risk of choking is low even with babies being placed on their backs to sleep. This applies to babies with reflux also. According to the AAP, the risk of SIDS outweighs the risk of your baby choking on their spit up or vomit.

The AAP does not recommend placing items in your baby’s sleeping space to elevate them or prop their heads up. Elevating your baby’s head may not work to prevent reflux symptoms and is not safe since the baby can roll into an unsafe position.

References

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