Focus on Severe Disabilities Control of Drooling The problem of drooling (sialorreah) is frequently a source of discussion and challenge for teachers of students with severe disabilities. It is estimated that 10-15% of children with cerebral palsy drool (Crysdale, Greenberg, Koheil & Moran, 1985; Weiss-Lambrou, Tetreault & Dudley, 1989). Drooling can have an adverse effect on the social and personal well being of the student. It is also a source of facial chapping and communicable disease transmission. Swallowing is generally a reflex. However, people with neurological damage or facial paralysis have difficulty swallowing due to poor jaw control and lip closure. Other possible causes of drooling are the use of tranquilizers and anti-convulsant medication or poor dental health. It is possible that a child who regularly drools is unaware that his face is wet due to a lack of sensory perception in many children with neurological damage. It is also possible that the child has become accustomed to the feeling of wetness and can no longer differentiate. To teach the concepts of wet and dry, the professional can talk about the differences between wet and dry while blowing warm air on the child’s face or hands. Also, taking advantage of water play, water fountains or hand washing time is a great time to teach and reinforce this concept. Several means are available to control drooling: nonaversive therapeutic techniques, drug therapy and surgical intervention. Within the school environment, techniques to control drooling consist of oral stimulation paired with improved positioning which encourage lip closure and increase swallowing. Your speech therapist and/or occupational therapist can assist you in facilitating these hands on interventions that assist the children with jaw control and stability of the head and neck. Some children have been known to use drooling to gain attention, or as a means of controlling their environment in which case a behavior modification program paired with a sensory motor program may be appropriate. This program is used with individuals who are motivated to change the drooling behavior and who have the cognitive ability to understand the consequences of changing the behavior. It should be noted that such a program can be very time consuming for both professionals and families and regression is probable when the reinforcer is removed. When it is determined that drooling is beyond the student’s ability to control, families have turned to medical techniques. One medical intervention is the use of drugs that decreases the amount of saliva secreted by the glands within the mouth. The three most commonly used drugs are scopolamine, glycopyrrolate and atropine sulfate (Hirsch, 1996). Although some patients who have used these drugs have shown improvement, there are side effects such as dry mouth, urinary retention, headaches and irritability. Finally, the most invasive means of decreasing or eliminating sialorrhea is surgery. There are several types of procedures that consist of removing, rerouting or disrupting the salivary glands in the mouth. However, as with most interventions, there are some disadvantages that include possible loss of taste, increased incidence of cavities, and aspiration. The decision to implement a program to reduce drooling is a team decision that should be given serious consideration. A therapeutic program can be time consuming and the coordination of all professionals and parents will have the greatest likelihood of success. For more information on therapeutic techniques to reduce silorreah, please see your speech therapist, occupational therapist, or check out the T-TAC resources listed below. References
T-TAC Library Resource List
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