Dr Louise Baker
Consultant Paediatrician S.I. Neurodisability, Department of Paediatrics,
Children’s Health Ireland
Drooling or dribbling is sometimes a problem for children who have a neurodisability such as cerebral palsy.
Saliva is important as it protects teeth, gums, prepares food for chewing and swallowing and supports oral hygiene.
Excessive Drooling is the inability to manage saliva flow. Consultant Paediatrician Dr Louise Baker explains that anterior drooling, where saliva comes out of the mouth and onto the face or clothes, can be distressing for a child. Posterior drooling, where saliva can trickle into the lungs, can lead to serious medical issues for vulnerable children.
Dr Baker explains that most people produce 0.5-1.5 litres of saliva and swallow 1200 times a day and for toddlers drooling is part of their typical development. Drooling beyond the age of four is abnormal and may need management. For children with any type of a neurological impairment, drooling can worsen and cause significant difficulties for the child and their family.
Drooling can be stigmatising, distressing and lead to a child being socially rejected, isolated and lacking self-confidence.
However, interventions and therapies are available to treat drooling, which is generally defined as an inability to efficiently and safely manage saliva.
Risk of infection
Drooling can impact on many aspects of life depending on its nature and severity. It can occur in more than 40% of children with cerebral palsy and can vary from mild to severe.
As saliva contains bacteria and yeast, it can cause recurrent respiratory tract infections. Cough, reduced speech clarity or choking episodes can also be common in this group of children and adults.
Management of drooling
Treatment, via a multi-disciplinary team, is recommended as best practice in assessment and management says Dr Baker. “When the drooling is defined as a behavioural problem with too little swallowing and wiping, a goal would be to increase the frequency of swallowing and/or wiping.” Management options vary from conservative methods with input from a speech and language therapist to medications or surgical intervention.
“If children are having recurrent respiratory infections, it is important to treat them urgently with suitable medication. We know from the studies that medication can give a very good outcome, but these children need to be monitored regularly and the adjustment of the dose according to the size of the child is important,” she says.
If a parent is concerned their school-aged child is drooling excessively, they should have it checked out by a Speech and Language therapist, GP or a paediatrician.
Treatment for more serious cases can mean injecting Botulinum toxin into the salivary glands, or surgery on the salivary gland ducts.
Dr Baker says: “There is a huge spectrum of children who can have saliva control and drooling issues. Some children have a lot of secretions that can have an unpleasant odour, it can damage books and equipment and impede their successful integration into school and the community.”
However, while drooling can be controlled or managed, she emphasises that the treatment goals can vary according to the severity of the condition.
It may range from cutting the number of times wet clothes or bibs need to be changed to reducing admissions to hospital for recurrent serious respiratory conditions caused by poor saliva control.
Stressing the importance of assessing why a child may be drooling she says: “If a parent is concerned their child is drooling more than they should, they should be checked out by a speech and language therapist, GP or paediatrician.”
Finding the right support
Dr Baker practices in Dublin at Children’s Health Ireland, the country’s largest paediatric hospital, and the Central Remedial Clinic in Clontarf, where she runs specialist clinics for children with neuro-disabilities.
Her goal is to establish a drooling service in Ireland with a multi-disciplinary approach in a clinical setting with speech therapists, paediatricians, dentists and nurse specialists to assess children and offer treatment.
“Drooling is a long-standing chronic condition that we should be treating especially in children who have a neurodisability,” she says. “We do need to set this service up in Ireland because drooling can cause such difficulties for children and their families.”