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What is the effectiveness and safety of different interventions in the management of drooling in children with cerebral palsy?
  1. Sujata Khajuria1,
  2. Khuen Foong Ng2,
  3. Rosalind J Jefferson3
  1. 1 Community Paediatrics, St. Mary’s Hospital, Northamptonshire NHS Foundation Trust, Kettering, Northamptonshire, UK
  2. 2 Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 Paediatric Neurodisability, Royal Berkshire NHS Foundation Trust, Reading, UK
  1. Correspondence to Dr Khuen Foong Ng, Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester LE18 3PR, UK;{at}

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A 10-year-old boy with spastic quadriplegic cerebral palsy (CP) was admitted into the hospital with a lower respiratory tract infection. His parents complained that he had a problem with excessive drooling of saliva; they had tried different treatments but to no avail. There was no formal guidance on the management of drooling in CP in the hospital. This raised the question regarding the effectiveness and safety of different interventions in the management of drooling in children with CP.

Structured clinical question

In a child with CP (patient), which is the treatment with maximum effectiveness and minimum adverse effects (intervention) to reduce sialorrhoea (outcome)?


MEDLINE, Embase, PsychINFO, AMED, PubMed, CINAHL, Cochrane Library and Google Scholar were searched from 1 January 1980 to 23 January 2020 and reference lists also scoured. Searches used synonyms of ‘drooling’ (sialorrhoea, hypersalivation, ptyalism, slobbering), ‘cerebral palsy’, ‘children’ and management/intervention/therapy. Two hundred and twenty-one unique records were screened (online supplementary figure 1) and 14 studies with 510 participants were included (table 1). Six studies evaluated the efficacy of botulinum toxin type A (BoNT-A) and one evaluated botulinum toxin type B (BoNT-B). Five trials examined pharmacological interventions: benztropine, glycopyrrolate and hyoscine. Three studies evaluated non-pharmacological non-invasive interventions: kinesio taping, oromotor exercises, functional chewing training and behavioural techniques. One randomised controlled trial (RCT) compared BoNT-A with submandibular duct ligation. No RCTs or controlled clinical trials could be retrieved on acupuncture or intraoral devices.

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Table 1

Summary of included studies


CP describes a group of permanent …

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  • Contributors SK conceptualised and designed the study, prepared the protocol, screened studies, abstracted data, completed risk of bias evaluation, performed the analysis and prepared the first draft of the manuscript. KFN and RJJ reviewed the screened studies and analysis, examined, edited and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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