Sialorrhoea

Sialorrhoea can be a problem in around 40% of people with cerebral palsy, and is usually due to inefficient control of normal salivary secretions. It can be exacerbated by poor posture, oral or dental disease, gastro-oesophageal reflux and medications (eg clonazepam). Pooled saliva causes drooling, but can also result in aspiration and recurrent respiratory infection (see also Chronic lung disease and aspiration).

Poor saliva control can have significant health, cosmetic and social consequences (eg wet smelly clothes, damaged equipment or aids), and cause skin irritation or maceration. These can be reduced by wiping the face and wearing absorbent wristbands (eg tennis wristbands) and scarves or cravats to absorb saliva—these are more appropriate than bibs after infancy.

Initial assessment of sialorrhoea should include oral and dental health review and medication review. For advice on assessing and managing swallowing difficulties, see Dysphagia in people with developmental disability.

Management of sialorrhoea includes addressing underlying issues and interventions to improve saliva control. These include behaviour modification (eg encouraging swallowing more frequently), biofeedback and oromotor therapy (eg providing exercises to assist mouth closure); refer to a specialist saliva control clinic, speech pathologist and rehabilitation physician.

Evidence for pharmacological therapy to manage excessive saliva is limited; anticholinergic drugs (eg trihexyphenidyl [benzhexol], benzatropine, glycopyrronium bromide [glycopyrrolate]) may be helpful in drying secretions in cerebral palsy, but adverse effects can be significant. For further information, see The American Academy for Cerebral Palsy and Developmental Medicine management algorithm for sialorrhoea.

Surgical options for saliva control in people with cerebral palsy include:

• injection of Botulinum toxin A into salivary glands
• removal of salivary glands or redirection of salivary ducts—this requires rigorous attention to oral and dental health with regular dental checks, because of the protective role of saliva on teeth.

For strategies for families and clinicians to manage drooling in children, see the Royal Children’s Hospital website.