Effect of Sialorrhea on Quality of Life in Cerebral Palsy Children

Main Article Content

Maryam Ashraf
Anum Ashraf
Rooma Imtiaz
Rabia Azmat


Background: Sialorrhea, characterized by uncontrollable drooling, is notably prevalent among children with Cerebral Palsy (CP). It emerges as a pathological concern after the age of 4, significantly impairing the quality of life (QoL) due to social stigmatization, perpetual clothing soiling, dehydration risks, speech obstructions, and potential for social withdrawal.

Objective: To quantify the impact of sialorrhea on the QoL of children with CP, as reported by their parents or caregivers.

Methods: Utilizing a cross-sectional study design with convenience sampling, data were gathered from a mix of government and private special education facilities in Lahore and Sialkot. A cohort of 100 CP children, aged between 4 and 12 years, was assessed using the Drooling Impact Scale (DIS) and the Cerebral Palsy Quality of Life Questionnaire for Children (CP-QOL-Child) parent-report version.

Results: The study population had an average age of 7.52 years, ranging from 4 to 12 years. Of the participants, 56 were male (56%) and 44 were female (44%). Analysis of the CP-QOL-Child data indicated that sialorrhea profoundly compromises the QoL in CP children, evidenced by a reduction in scores related to social well-being and acceptance by an average of 37.5%. Furthermore, the children's participation in community and social events showed a significant decline, with average participation rates reported at just 30%.

Conclusion: The study conclusively demonstrates that sialorrhea is associated with a reduced QoL in children with CP. The significant numerical values reflecting poor social integration and lowered activity participation underscore the urgent need for comprehensive management strategies to alleviate the impact of sialorrhea. Enhancing these children's ability to engage in social and communal experiences is imperative for improving their overall QoL.

Article Details

How to Cite
Ashraf, M., Ashraf, A., Imtiaz, R., & Azmat, R. (2023). Effect of Sialorrhea on Quality of Life in Cerebral Palsy Children. Journal of Health and Rehabilitation Research, 3(2), 23–29. Retrieved from https://jhrlmc.com/index.php/home/article/view/42
Author Biographies

Maryam Ashraf, Riphah International University

Speech Language Pathology

Anum Ashraf, Johar Medicare Complex

Speech Language Pathologist

Rooma Imtiaz, Sehat Medical Complex

Speech Language Pathologist

Rabia Azmat, Govt. Special Education Center Jhang

Speech Language Pathologist


Anjugam P, Mathian VM, Gawthaman M, Vinod S, Devi EYJRMMJ. Salivary biomarker levels and oral health status of children with cerebral palsy and their healthy siblings: a comparative study. 2021;12(2).

Khandaker G, Muhit M, Karim T, Smithers‐Sheedy H, Novak I, Jones C, et al. Epidemiology of cerebral palsy in Bangladesh: a population‐based surveillance study. 2019;61(5):601-9.

Marpole R, Blackmore AM, Gibson N, Cooper MS, Langdon K, Wilson AC. Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy. Frontiers in pediatrics. 2020;8:333.

Speyer R, Cordier R, Kim JH, Cocks N, Michou E, Wilkes-Gillan S. Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Developmental medicine and child neurology. 2019;61(11):1249-58.

Sadowska M, Sarecka-Hujar B, Kopyta IJNd, treatment. Cerebral palsy: Current opinions on definition, epidemiology, risk factors, classification and treatment options. 2020;16:1505.

Whitney DG, Warschausky SA, Peterson MD. Mental health disorders and physical risk factors in children with cerebral palsy: a cross-sectional study. 2019;61(5):579-85.

Syed Faizati All Shah WSJFMASAM. Health Status of Children with Cerebral Palsy: A Cross Sectional Study in Karachi. Journal of Peoples University of Medical & Health Sciences Nawabshah (JPUMHS). 2016;6(2):60-4.

Park E-Y. Path analysis of strength, spasticity, gross motor function, and health-related quality of life in children with spastic cerebral palsy. Health and Quality of Life Outcomes. 2018;16(1):70.

Güvenç IAJSG-NAiD, Treatment. Sialorrhea: a guide to etiology, assessment, and management. 2018.

Dias BLS, Fernandes AR, Maia Filho HdSJJdp. Sialorrhea in children with cerebral palsy. 2016;92:549- 58.

Russo EF, Calabrò RS, Sale P, Vergura F, De Cola MC, Militi A, et al. Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study. Int J Med Sci. 2019;16(11):1447- 52.

McInerney M, Reddihough DS, Carding PN, Imms C. Drooling in children with neurodisability: A survey of Australian speech–language pathologists’ practice. International Journal of Speech-Language Pathology. 2020;22(5):601-9.

Reid SM, Westbury C, Guzys AT, Reddihough DSJDM, Neurology C. Anticholinergic medications for reducing drooling in children with developmental disability. 2020;62(3):346-53.

Dias BLS, Fernandes AR, Maia Filho HdS. Sialorrhea in children with cerebral palsy. Jornal de pediatria. 2016;92:549-58.

Chaléat-Valayer E, Porte M, Buchet-Poyau K, Roumenoff-Turcant F, D'Anjou M, Boulay C, et al. Management of drooling in children with cerebral palsy: a French survey. European Journal of Paediatric Neurology. 2016;20(4):524-31.

Ozdemir O, Tezcan S. Quality of Life in Children with Cerebral Palsy. 2017.

Sabado J, Owens LJCP. Medical Management of Sialorrhea in the Child with Cerebral Palsy. 2020:783- 98.

Paine CC, Snider JW. When saliva becomes a problem: the challenges and palliative care for patients with sialorrhea. Ann Palliat Med. 2020;9(3):1333-9.

Verhoeff MC, Koutris M, Vries R, Berendse HW, Dijk KDV, Lobbezoo F. Salivation in Parkinson's disease: A scoping review. Gerodontology. 2023;40(1):26-38.

Sanagustin D, Martin-Subero M, Hogg B, Fortea L, Gardoki I, Guinart D, et al. Prevalence of clozapine-induced sialorrhea and its effect on quality of life. Psychopharmacology. 2023;240(1):203-11.

Lynch K. Optimizing pharmacologic treatment for ALS to improve outcomes and quality of life. The American journal of managed care. 2023;29(7 Suppl):S112-s9.

Hirayama T, Shibukawa M, Yanagihashi M, Warita H, Atsuta N, Yamanaka K, et al. Investigation of non-motor symptoms in patients with amyotrophic lateral sclerosis. Acta neurologica Belgica. 2023;123(5):1797-804.

Gulati A, Kidane J, Chang JL. Patient Reported Outcome Measures for Salivary Function: A Systematic Review. The Laryngoscope. 2023;133(8):1796-805.

Grippe T, Chen R. Botulinum toxin in the management of parkinsonian disorders. Toxicon : official journal of the International Society on Toxinology. 2023;232:107209.

Hughes A, Lambert EM. Drooling and Aspiration of Saliva. Otolaryngologic clinics of North America. 2022;55(6):1181-94.

Cuvelier E, Gressier B, Fovet T, Simon N, Décaudin B, Amad A. [Treatment options for drug-induced sialorrhea: Prescribing guidelines]. L'Encephale. 2022;48(6):700-11.

Tamadonfar ET, Lew MF. BoNT clinical trial update: Sialorrhea. Toxicon : official journal of the International Society on Toxinology. 2023;226:107087.

Shao M, Chen K, Wu X, Lin J, Jiang M, Zhuo F, et al. Botulinum toxin in the treatment of sialorrhea in severe neurological patients with tracheotomy. Brain and behavior. 2023;13(8):e3164.

Schep LJ, Slaughter RJ, Watts M, Mackenzie E, Gee P. The clinical toxicology of ketamine. Clinical toxicology (Philadelphia, Pa). 2023;61(6):415-28.

Heikel T, Patel S, Ziai K, Shah SJ, Lighthall JG. Botulinum Toxin A in the Management of Pediatric Sialorrhea: A Systematic Review. The Annals of otology, rhinology, and laryngology. 2023;132(2):200-6.

Daniel SJ, Fayoux P, Bateman N, Boudewyns A, Brigger M, Chan CY, et al. Comprehensive management of anterior drooling: An International Pediatric Otolaryngology Group (IPOG) consensus statement. International journal of pediatric otorhinolaryngology. 2023;168:111500.

Hughes A, Lambert EM. Drooling and Aspiration of Saliva. Otolaryngologic clinics of North America. 2022;55(6):1181-94.