Interventions for drooling in children with cerebral palsy

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Drooling is a common problem for children with cerebral palsy (CP). Drooling varies in severity and can be distressing for the children, families and caregivers. It can cause chapped or sore skin around the mouth and chin, skin and mouth infections, dehydration, difficulties chewing and a range of other social issues.  The main aim of this Cochrane review was to evaluate the effectiveness and safety of interventions aimed at reducing or eliminating drooling in children with CP.

The Cochrane Central Register of Controlled Trials (CENTRAL); Medline; Embase; CINAHL; ERIC; Psych INFO; Web of Science; Web of Knowledge; AMED; SCOPUS; and Dissertation Abstracts databases were searched together with a range of relevant journals and conference proceeding abstracts. The Clinical Trials and Current Controlled Trials databases were searched for ongoing trials.

Only randomised controlled trials (RCTs) and controlled clinical trials (CCTs) were included.

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.
  •  In the studies eligible for review, there was considerable heterogeneity within and across interventions. Consequently meta-analysis 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. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008624. DOI: 10.1002/14651858.CD008624.pub2.

 

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