The challenges of posterior drooling in children with cerebral palsy

This commentary is on the original article by Delsing et al. pages 1093–1098 of this issue. Posterior drooling an under-researched problem in individuals with cerebral palsy. The symptoms posterior (which include coughing and choking secretions) are inevitably extremely distressing both for children (or adults) their families or carers, may significantly impact sleep quality life. Chronic aspiration materials (including saliva) results recurrent chest infections lung damage, respiratory disability, death.1 Children neurological impairment seem to be at greatest risk group often silent (up 92% thick fluid consistency).2 raises question as whether severe should investigated aspiration. Many these gastrostomy-fed reduce However, despite lack oral feeding, salivary still problematic, although it also occurs non-disabled during vary from night when studies repeated. Also, there currently a evidence how much needed cause significant disease differs person person. al.’s study therefore highlights problem. Their retrospective (n=92 participants) compared three approaches treatment, all targeting submandibular glands; botulinum toxin injections, gland excision (SMGE), bilateral ligation ducts.3 Valid measurements severity frequency never easy, even anterior drooling, but more difficult which no criterion standard measurement tool. used visual analogue scale (VAS) document range (congested breathing, coughing, gagging over preceding 2 weeks. More invasive diagnostic techniques (e.g. radionuclide salivagrams4) demonstrate were not undertaken, mention, investigations challenging group. found that, overall, while VAS scores lower 8 weeks baseline, was difference 32 weeks.3 Reasons non-sustained improvement unknown. Nevertheless, seemed clear that SMGE preferred procedure reduction period most marked Lower tract infection secondary outcome, based history medical record review. As such, limited method known inaccurate. Furthermore, times unequal (baseline=1y pre-intervention; post-intervention=32wks after treatment). follow-up length relatively short. Recurrence due production remaining glands occur. Although few adverse events, can result increased dental caries, particularly central incisors, where uncommon.5 Prolonged cohort 5 years would great interest importance. congratulated highlighting important They have raised awareness about knowledge best management condition. Future prospective, designed collaboration young people families, longer period. long-term use anticholinergic medication repeated doses need surgical approach. Further, precise tools non-invasive so various treatments better evaluated.