EXCESSIVE SECRETIONS

Excessive secretions is a sign that is seen in approximately 1/3 of infants with Neonatal Abstinence from any substance. Excessive mucous and drooling is noted at times accompanied with congestion. Signs may include, but are not limited to: noisy breathing, excessive saliva, or pooling of secretions in the mouth. This is very commonly seen in infants with stimulant (methamphetamine, cocaine) exposure as well as opioid exposure.

NOTE: The Following Videos found in this kit under the Parenting Tips from Specialists will provide more information and/or demonstration that might be useful for some of the interventions recommended here.

NAS: Early Interventions

NAS and Muscle Tone

NAS & Feeding

Sucking and Feeding Devices

STRATEGIES BY DISCIPLINE

NEURODEVELOPMENT

  • Determine root cause by consultation with your baby’s doctor.

  • Be aware that excessive secretions can be related to food sensitivity often resulting in congestion. You may want to discuss a formula change with the baby’s doctor.

  • Drooling may be related to low muscle tone around the mouth and wiping up (not down when the baby drools) and infant massage around the mouth can help reduce the drooling.

MEDICAL

  • Determine the root cause of the excessive secretions with the help of your baby’s doctor.

  • Your baby’s doctor may want to know:

    • If the baby has difficulty breathing or feeding

    • Is the baby congested?

    • Does the baby have allergies?

NURSING

  • Tell your Baby’s doctor about the frequent excessive secretions.

  • Remove the excessive secretions using a bulb syringe.

  • Monitor the baby’s breathing; let the doctor know if you have concerns about how your baby is breathing.

  • If your baby has excessive secretions, it will be important to discuss sleep positions with your baby’s doctor. They sometimes recommend a small wedge under the mattress to elevate your baby’s head, so they don’t choke on their secretions.

  • You may want to consider a formula change if the infant has a sensitivity to the formula that is causing excessive secretions.

OCCUPATIONAL THERAPY

  • The Joy of Tough Time (amazon.com) has strategies for infant massage for face and nose if congestion is present.

  • Ask for a referral to an OT or Speech therapist who has experience assessing oral motor function.

SPEECH PATHOLOGY

  • Keep the chin dry and wipe upwards with a soft dry cloth.

  • When the baby is calm introduce a pacifier and use the pacifier to increase the strength of the muscles around the baby’s mouth.

  • Make sure to keep the baby’s head higher than hips to prevent aspirations of mucous or pooling of the secretions.

    • Note babies with excessive secretions are more likely to have ear infections due to the pooling of the secretions so it is very important to keep head higher than hips especially during feeding and 30 minutes after feeding.

    • If your baby has more than 2 ear infections, you should ask your baby’s doctor for a referral to an ENT doctor to assess for excessive fluid/secretions and pooling.