return to: Hypersalivation Ptyalism Sialorrhea; Transdermal scopolamine and glycopyrrolate for sialorrhea and salivary fistula

1. Obtain History:
   1. How long has the excessive drooling occurred?
   2. What interventions have been trialed?
      1. What was successful?
      2. What was unsuccessful?
   3. Does the patient have a history of pneumonia or aspiration?
   4. Is the patient eating an oral diet?
   5. Is the patient aware of this issue? How is it affecting the patient/their caregivers?
2. Observation and Oral Mechanism exam:
   1. Determine nature of drooling. Anterior or posterior?
   2. Determine if possible weakness in oral structures could be contributing to drooling
   3. Assess ability to swallow on-command
   4. Assess if any oral aversion exists
3. Trial of non-surgical/medical interventions:
   1. Optimizing Positioning and Set-Up (with coordination from Physical Therapy):
      1. If anterior drooling is noted and patient exhibits an ability to swallow, consider posterior-leaning posture to facilitate improved saliva containment and clearing of secretions via swallows
      2. Ensure adequate trunk support and head control
      3. Handkerchiefs, bibs or apron-like coverings can be used to absorb fallen saliva, depending on where saliva falls due to positioning
   2. Oral motor exercises:
      1. If patient displays inadequate oral motor strength, SLP may consider exercises to increase jaw stability, lip closure and lingual strength and mobility. Patient must be able to safely breathe through nose as jaw exercises will require frequent and/or sustained closing of mouth. Oral aversion may impact ability to complete exercises.
   3. Behavioral:
      1. Increase frequency of swallows
         1. This can be done with use of drinks if permitted or via non-nutritive swallows if patient is NPO
         2. SLP may suggest sipping on water or another liquid during non-meal times to increase swallow frequency
      2. Independent wiping
         1. If patient is able to wipe his/her face, SLP may consider using a variety of cues to encourage the patient to purposefully wipe away excessive saliva. Apps with a visual or sound reminder can also be used if verbal prompts are ineffective or are not well received by the patient
         2. Caregivers and family are encouraged to trial a variety of cloths, towels, sweatbands (wrist) to see what type of absorbent agent is best received. These cloths can show favorite images, characters, sports logos, etc.
   4. Oral prosthetics (Completed by Dental and/or Otolaryngology teams)

References

American Academy for Cerebral Palsy and Developmental Medicine: https://www.aacpdm.org/publications/care-pathways/sialorrhea