Cochrane review finds insufficient evidence to inform clinical practice on interventions for drooling in children with cerebral palsy


Oral motor difficulties in children and young people with learning disabilities can lead to saliva overflow, commonly called drooling. With young people with profound intellectual and multiple disabilities, this can increase the risk of inhaling saliva, food, or fluids into the lungs.

Our friends at the Dental Elf came across this systematic review of interventions for drooling in children with cerebral palsy, which we thought our readers may find useful.

Drooling can cause chapped or sore skin around the mouth and chin, and can lead to skin and mouth infections, dehydration, difficulties chewing and a range of other issues.  The Cochrane review set out to evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with cerebral palsy.

The reviewers included only randomised controlled trials (RCTs) and controlled clinical trials (CCTs).

Six studies were included in the review.  Four were trials using botulinum toxin-A (BoNT-A) and two were trials on the pharmacological interventions, benztropine and glycopyrrolate.

No RCTs or CCTs were retrieved on surgery, physical, oro-motor and oro-sensory therapies, behavioural interventions, intra-oral appliances or acupuncture.

A meta-analysis of the studies eligible for review was not possible, so a descriptive summary was provided.

All studies showed some statistically significant change for treatment groups up to 1 month post intervention. However, there were methodological flaws associated with all six studies.

The authors concluded

It was not possible to reach a conclusion on the effectiveness and safety of either BoNT-A or the pharmaceutical interventions, benztropine and glycopyrrolate. There is insufficient evidence to inform clinical practice on interventions for drooling in children with CP. Directions for future research are provided.

Walshe M, Smith M, Pennington L. Interventions for drooling in children with cerebral palsy, Walshe M et al., Cochrane Database of Systematic Reviews 2012, Issue 2,

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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