DESCRIPTION

• Drooling, or poor saliva control, can be normal in the first 2 years of life when children are developing oral-motor function.
• After 4 years of age, it is considered abnormal to exhibit persistent drooling.
• Drooling is a significant problem for many children with cerebral palsy, intellectual disability, and other neurologic impairments.
  • Drooling can cause skin irritation, cracked lips, and odor. In children unable to manage pooling secretions, there is also a risk of aspiration.
  • There is also a significant social impact, as children often soak bedding, clothes, and toys and require frequent clothing and bib changes. It can lead to social isolation and, in individuals with higher intellectual functioning, self-consciousness and depression.

EPIDEMIOLOGY

• Estimates vary widely, but anywhere between 10% and 60% of children with cerebral palsy have pathologic drooling.
• In children with cerebral palsy, the Gross Motor Function Classification Score is not a good predictor of drooling severity, but children with drooling do have more oromotor dysfunction.

RISK FACTORS

• Cerebral palsy
• Neurodevelopmental disabilities
• Tracheotomy
• Abnormalities in facial morphology
• Dental malocclusion and open mouth posture

GENERAL PREVENTION

• Posture/positioning, head of bed elevation, nasal saline sprays
• Dental hygiene and care

PATHOPHYSIOLOGY

• Saliva is primarily produced from the three pairs of major salivary glands and from minor glands in the oral cavity and palate.
  • The relative contributions to volume are submandibular glands 60%, parotids 30%, sublingual glands 5%, and minor glands 5%.
  • Children produce 500 to 2,000 mL of saliva a day.
• The cause of drooling in most children is not overproduction of saliva but impaired lip control, causing a delay between the suction and propelling stages of the oral phase of swallowing. Consequently, saliva from the sublingual and submandibular glands pools in the anterior floor of mouth and spills out.
• Other contributing factors can include absent or impaired oropharyngeal sensation, abnormal movements of tongue and lips, and reduced frequency of swallowing or dysphagia.
• Anterior drooling occurs when saliva spills from the mouth and is clearly visible.
• Posterior drooling occurs when saliva spills through the oropharynx into the hypopharynx.

COMMONLY ASSOCIATED CONDITIONS

Children with syndromes that include hypotonia may require tracheotomy for airway control.