Drooling and Cerebral Palsy

What is drooling?

Drooling (or dribbling) is the unintentional loss of saliva from the mouth. It occurs naturally in very young children, but as the child 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 happen?

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

In cerebral palsy, drooling is usually related to:

• abnormalities in swallowing (rather than an 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 likely to drool?

Drooling occurs in about one third of people with cerebral palsy. It may also occur in people with acquired brain damage, learning disability, Parkinson’s Disease, during epileptic seizures, in facial paralysis, speech disorders, in nasal obstruction and when consciousness has been lost 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 a lot of the time. 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 cause of the drooling. It is necessary, therefore, for the causes of the 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 (swallowing and chewing) 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

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.