What is the effectiveness and safety of different interventions in the management of drooling in children with cerebral palsy?

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. 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. ### Supplementary data [archdischild-2020-319309supp001.pdf] View this table: Table 1 Summary of included studies CP describes a group of permanent …