Drooling (sialorrhea) occurs in approximately 40% of individuals with cerebral palsy. It may be visible, with saliva spilling out the of the mouth, or less obvious and involve saliva pooling in the back of the throat. Sometimes both types of drooling may occur together.
It’s important to receive treatment for drooling since it can have significant medical and social impacts for the individual. At this time there is not a perfect curative treatment available, but oromotor and behavioral training may be helpful. Other individuals may require medications or botulinum toxin injections, or surgical interventions.
Cerebral Palsy and Drooling: Assessments and Treatments
A multi-disciplinary approach (with specialists working together) is ideal for assessing and addressing concerns related to drooling. They may appear independently or may co-exist. It is important to distinguish between anterior and posterior drooling since the treatments may vary. Repeated episodes of pneumonia, repeated antibiotic use for respiratory reasons, evidence of chronic inflammatory lung disease, and significant need for suctioning are often used by professionals as indicators of posterior drooling. Additional assessment tools to consider using include salivagram and fiberoptic endoscopic evaluation of swallowing; however, they may not be necessary or appropriate.
For drooling that is visible (anterior drooling), there are treatments that aim to help children manage their symptoms by increasing control of their swallowing muscles and by teaching them to swallow more often or to wipe away saliva. There are also appliances that can be placed in the person’s mouth to help control this type of drooling but the effectiveness of this approach is unclear.
Drooling that pools in the back of the throat (posterior drooling) can cause repeated infections of the lungs as well as difficulty with breathing or clearing the throat. When this type of drooling is present the treatments above are not effective. For these individuals, and for people with CP who are unable to control their swallowing muscles or wipe away their saliva, treatment often includes medicines which help to dry up the secretions. Botulinum toxin injections to the saliva glands can also be helpful; however, repeated injections are typically required approximately every 6 months. Surgical interventions may also be recommended.
Why Addressing Drooling is Important?
Medical concerns:
- The pooling of saliva in the back of the throat can cause aspiration, infections and sometimes progressive lung disease.
- Saliva that remains on the chin causes can cause skin irritation and lead to skin break down.
Social-emotional concerns:
- Drooling from the front of the mouth may result in the need for clothing changes.
- Social embarrassment may lead to isolation and low self-esteem.
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