Excessive drooling (sialorrhea) has been associated with a 10%-37% of children with developmental disabilities. Among children with cerebral palsy who attend special schools, the incidence is 58%. In a survey of parents of 1,437 children with cerebral palsy, approximately 50% reported that drooling is an issue for their child both physically and psychologically. 16% even stated that excessive drooling requires daily changes of clothing.
Many of the complications related to sialorrhea can generate health problems such as:
- Perioral chapping, irritation, and maceration, with secondary infection of the facial skin
- Dehydration due to chronic loss of fluids
- Increased risk of silent saliva aspiration that can result in recurrent respiratory infections
Social limitation is another complication for children in the education system, where drooling can:
- Cause an embarrassing wetness and odor
- Inhibit vocational opportunities
- Prevent children from experiencing basic developmental skills such as sharing and independence
In an attempt to manage drooling problems associated with cerebral palsy and other neurological conditions, I studied the effectiveness of using glycopyrrolate oral solution (1 mg/5 mL) with these children.
38 patients ages 3-23 years were studied, some given glycopyrrolate oral solution, some given a placebo. All patients were considered to have severe drooling (clothing damp 5-7 day/week).
The results show that improvements started 2 weeks after treatment initiation, with improvements at the 8-week mark being even greater. In addition, 100% of parents/caregivers regarded glycopyrrolate oral solution to be worthwhile, while just 56% found the placebo worthwhile.
Only a few mild side effects were associated with this glycopyrrolate in this study, mainly dry mouth, constipation, and vomiting.
Drooling can be a serious problem for children, and our hope is to find the best ways to manage this concern in children with development disabilities.