SY Hau, HMY Ng, JYY Ngan, CWL Lau, CH Ko

Abstract

Objective: Drooling is a common problem in children with neurological problem, leading to physical and psychological complications. The aim of this study is to share our experience on managing this group of children and evaluate the effectiveness of a Sialorrhoea Improvement Program. Method: Retrospective review of children attending the Drooling Clinic of Caritas Medial Centre in Hong Kong from May 2015 to October 2023. Under the Sialorrhoea Improvement Program, children were managed jointly by paediatric neurologists and occupational therapists. They received treatment including occupational therapy, transdermal scopolamine and/or botulinum toxin injection. For anterior drooling group, severity was measured by Drooling Severity (DS), Drooling Frequency (DF), Visual Analogue Scale (VAS), 10-minute drooling quotient (DQ10), and the number of bibs per day. For posterior drooling group, severity was measured by the number of chest infection over 6 months. Baseline and post-treatment outcome scores were compared. Results: 23 children with 28 treatment episodes were included. Among 17 episodes in anterior drooling; DS improved from 3.7 (baseline) to 2.5 (post-6 months, p<0.005). DF improved from 3.2 (baseline) to 2.1 (post-6 months, p<0.005). DQ10 improved from 30.0% (baseline) to 7.2% (post-6 months, p<0.005). VAS improved from 6.2 (baseline) to 3.5 (post-6 months, p<0.005). Number of bibs per day improved from 5.5 (baseline) to 3.1 (post-6 months, p<0.005). Subgroup analysis demonstrated improvement of DS, DF, DQ10, VAS, number of bibs per day in both transdermal scopolamine and botulinum toxin injection. Among 11 treatment episodes in posterior drooling, the mean number of chest infection over 6 months diminished from 3.5 to 1.5 post botulinum toxin injection (p=0.007). Regarding safety profile, side effects with allergy and transient tiredness were reported in transdermal scopolamine group. None experienced side effect with botulinum injection. Conclusion: Sialorrhoea improvement program with occupational therapy, transdermal scopoline and botulinum toxin injection, provided a sustained improvement in children with anterior drooling problem. Side effects were more common with transdermal scopolamine. Botulinum toxin A injection is effective to decrease posterior drooling and reduce frequency of chest infection from aspiration.