title: Managing children with sialorrhoea (drooling): Experience from the first 301 children in our saliva control clinic.
abstract: OBJECTIVE
  Sialorrhoea (drooling) is defined as the involuntary escape of saliva from the mouth. It is considered normal in young children but may cause social problems in older children. Sialorrhoea is frequently seen in children with cerebral palsy, with rates between 10% and 58% and in other neurodevelopmental diseases. Management of these children can be challenging and often requires an individual and stepwise approach. This is a large case series of children managed at the saliva control clinic in Glasgow, Scotland.
  
  
  METHODS
  A chart review of all children attending the saliva control clinic between 2006 and June 2012 was performed. This was to ensure that all children would have long term follow up (3 years minimum). Drooling severity was assessed on the child's first attendance at clinic, and at review following a treatment option, using the Teacher Drooling Scale (TDS).
  
  
  RESULTS
  The total number of children attending this clinic was 301, of which 274 had adequate records for inclusion in the study. 176 (64%) were male. The mean age was 7.3 (median 5) years. In terms of development 35 (13%) of children were developing normally and 50 (18%) had general developmental delay. There were 105 (38%) children with cerebral palsy. The final management of sialorrhoea in these children was simple reassurance and advice for 34 (12%), speech and language therapy for 62 (23%) anticholinergics in 90 patients (33%), botox for 30 (11%) and surgery for 71 (26%) children. The rate of non-tolerance of anticholinergics is 30%; 90 of the 298 children tried on anticholinergics had side effects leading to the treatment being stopped. The average teachers drooling score was 4.24 before clinic and 1.59 after clinic. Satisfactory results were achieved in 215 (78%) of children.
  
  
  CONCLUSIONS
  Our data illustrates that effective patient management requires all treatment options to be available, including speech therapy, medications, botulinum toxin and surgery. This is one of the larger case series of children attending a saliva control clinic.
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom. Electronic address: jennifer.montgomery@nhs.net.
authors.forename: Jenny
authors.initials: J
authors.lastname: Montgomery
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: McCusker
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Kerry
authors.initials: K
authors.lastname: Lang
authors.affiliation: Department of Speech & Language Therapy, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Grosse
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Alastair
authors.initials: A
authors.lastname: Mace
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Ruby
authors.initials: R
authors.lastname: Lumley
authors.affiliation: Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Rd, Govan, Glasgow G51 4TF, United Kingdom.
authors.forename: Haytham
authors.initials: H
authors.lastname: Kubba
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000293:Adolescent; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D002658:Developmental Disabilities / Q000150:complications; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D065886:Neurodevelopmental Disorders / Q000150:complications; D013517:Otorhinolaryngologic Surgical Procedures; D012107:Research Design; D012189:Retrospective Studies; D012463:Saliva; D012606:Scotland; D012798:Sialorrhea / Q000209:etiology / Q000628:therapy*; D013070:Speech Therapy; D013363:Submandibular Gland / Q000601:surgery*; D055815:Young Adult
chemical_list: D065087:Acetylcholine Release Inhibitors; D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A
keywords: Child; Drooling; Interdisciplinary communication; Otolaryngology; Salivary glands