Section I: Evidence Summary
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Sialorrhea refers to drooling of saliva as a result of limitations in a person’s ability to control and swallow oral secretions. Anterior drooling is defined as saliva spilled from the mouth that is clearly visible. Posterior drooling occurs when saliva spills through the oropharynx and into the hypopharynx. In children and youth with cerebral palsy (CP), sialorrhea is usually the result of limited oromotor control as a result of muscle incoordination and sensory perception difficulties rather than excessive salivation.
Sialorrhea occurs in approximately 40% of children/youth with CP and can have significant medical and psychosocial impact.
Target Population: Children/youth between the ages of birth and 25 years with CP who drool
Target Clinical Providers: Physicians, therapists, psychologists and nurses treating children/youth with CP who drool
A number of treatment strategies are available although there is no clear consensus as to which are safe and effective. Goals of treatment target: 1) improvement of oromotor control of secretions; 2) enhancement of a child’s ability to behaviorally manage secretions; and 3) reduction of saliva production or rerouting of salivary flow. When possible, a multidisciplinary team approach is recommended, progressing from conservative to more invasive treatments until saliva control is improved and side effects, if present, are manageable. Complete control is often not possible. Additionally, surgical intervention may not be curative. All of the strategies that follow may be appropriate for anterior drooling; oromotor and orosensory strategies, behavioral strategies, and oromotor appliances are not recommended for posterior drooling. Duct relocation is contraindicated for posterior drooling.
Whether or not an intervention is utilized, the psychosocial and medical effects of drooling must be monitored longitudinally. If an intervention is pursued, regular systematic monitoring of the child and caretaker for indications of efficacy and potential side effects is imperative.
A Cochrane report was available on the subject of sialorrhea in children with cerebral palsy and framed the core of this summary and algorithm. Additionally, a broad literature search was conducted to complement the report. This included review of lower level evidence studies which the team felt might further inform the range of choices clinicians confront in the treatment of sialorrhea. The results are being submitted for publication as a review article which will be posted after publication.
|Interventions for drooling in children with cerebral palsy.
Walshe M, Smith M, Pennington L.
Cochrane Database of Systematic Reviews
2012, Issue 11. Art. No.: CD008624. DOI: 10.1002/14651858.CD008624.pub3
|Saliva Control in Children
Royal Children’s Hospital Melbourne
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|Drooling Quotient Instructions (5-minute version)|
|Drooling Impact Scale|
|Corinne Delsing||Radboud University Medical Centre||Nijmegen, The Netherlands||Otorhinolaryngology|
|Laurie J. Glader, MD||Boston Children's Hospital
Harvard Medical School
|Boston, Massachusetts, USA||Pediatrician, Complex Care Medicine|
|Amy Hughes||Boston Children's Hospital
Harvard Medical School
|Boston, Massachusetts, USA||Pediatric Otolaryngology|
|Jeremy Parr, MB ChB, MRCPCH, MD||Institute of Neuroscience, Newcastle University||Newcastle upon Tyne, UK||Clinical Senior Lecturer and Consultant, Paediatric Neurodisability|
|Lindsay Pennington, PhD||Institute of Health and Society, Newcastle University||Newcastle upon Tyne, UK||Speech and Language Therapy|
|Dinah S. Reddihough, MD||Royal Children's Hospital
Murdoch Children's Research Institute
The University of Melbourne
|Parkville, Victoria, Australia||Developmental Medicine|
|Karen Van Hulst, MSc||Radboud University Medical Centre||Nijmegen, The Netherlands||Speech and Language Therapy/
|Jan JW Van Der Burg, PhD||St. Maartenskliniek & Radboud University||Nijmegen, The Netherlands||Psychologist|
The American Academy for Cerebral Palsy and Developmental Medicine has developed care pathways to assist the busy clinician. Please submit any advice or constructive feedback to make this pathway more useful.
NOTE: Feedback will be directed to the AACPDM Care Pathway Taskforce to review and consider on a queue 6-month basis.