Drooling and cerebral palsy

What is drooling?

Drooling (or dribbling) is the unintentional loss of saliva from the mouth. It occurs naturally in infants, but as the infant gets older it usually decreases. Daytime drooling stops within the first few years of life, though it may still occur in the older child during sleep. Drooling beyond the age of about four years is unusual, unless there is an underlying medical problem.

Why does drooling occur?

Drooling beyond infancy may occur in some medical conditions such as when there is inflammation of the mucous membranes of the mouth or as a reaction to some medications, which cause an increase in the amount of saliva produced.

In cerebral palsy, drooling is usually related to:

• abnormalities in swallowing (rather than to absence of swallowing)
• difficulties moving saliva to the back of the throat
• poor mouth closure
• jaw instability
• tongue thrusting

An excess production of saliva is not usually responsible for drooling. Instead it has been found that there is a tendency to swallow less frequently than normal.

Drooling can be made worse by a lack of head control and poor posture, lack of sensation around the mouth, breathing through the mouth, excitement and impaired concentration.

Who is vulnerable to drooling?

It is estimated that drooling can occur in about one-third of people with cerebral palsy. It may also occur in people with acquired brain damage, learning disabilities, Parkinsons disease, during epileptic seizures, in facial paralysis, speech disorders, in nasal obstruction and when consciousness has been interrupted for a short time. Drooling is, therefore, not only a condition found in childhood.

Drooling, health and hygiene

There are health and hygiene implications for people who drool most of the time and to excessive degrees. The skin around the mouth, chin and neck can become red and sore, dehydration may occur because of fluid loss, there may be problems with eating, infections may be more easily transmitted, and choking is more likely, as are chest infections.

What can be done?

A variety of techniques have been used to treat drooling. Some are more successful than others, but the treatment prescribed will depend upon the cause of the drooling. For example, someone with a severe learning disability is not likely to benefit from a training programme that demands a high level of co-operation and personal input. Equally, surgery for removal or re-siting of salivary glands would not be appropriate for someone who may have a nasal obstruction, which is a major contributor to the drooling. It is necessary, therefore, for the causes of drooling to be identified, usually by an ENT (ear, nose and throat) examination before treatment can be considered.

Treatments may include:

• reward or prompting to encourage swallowing
• surgery, where salivary glands are usually turned towards the back of the mouth so that saliva runs towards the back rather than the front of the mouth
• exercises to increase muscle tone, improve oral-motor function and improve sensory awareness
• medication, where drugs might be used to dry up salivary secretions
• removal of a salivary gland may be considered in extreme cases
• Botulinum toxin injections are now being used to help prevent and control drooling.

How to find help

Your family doctor can make referrals to specialist services. You can also contact speech and language therapy departments in hospitals or clinics without a referral. Such services can also be accessed through the private sector. More detailed information about speech and language therapy services can be obtained from:

The Royal College of Speech and Language Therapists
Tel: 020 7378 1200
Website: www.rcslt.org

For more information on Scope

Contact Scope Response for information, advice and support on cerebral palsy and disability issues. Copies of all our information sheets can be downloaded from our website or obtained from Scope Response.

Scope Response hours are:

Monday - Friday 9 am to 5 pm.
Closed weekends and Bank Holidays.

Scope Response
PO Box 833
Milton Keynes
MK12 5NY

Tel: 0808 800 3333 (freephone helpline)

Fax: 01908 321051

SMS Text: Type SCOPE plus your message to 80039

Email: response@scope.org.uk

Web: www.scope.org.uk

Scope acknowledges the help and support of everyone who has been involved in the production of this information. Although we have taken care to ensure the accuracy of this information, Scope cannot accept responsibility for errors or omissions. We always recommend getting independent advice from a professional before embarking on any process, therapy or medical intervention.

We have information about Scope and cerebral palsy available in some languages on CD-ROM. We also offer a telephone interpreting service to people whose preferred language is not English. Please contact Scope Response for more details of these services.

This information was last reviewed April 2010.

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