Drooling and Aspiration
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
Most children with drooling produce a normal volume of saliva; the problem is in controlling it. There are some children, however, who genuinely produce too much saliva (true hypersalivation). This includes children with dyskinetic cerebral palsy, where hyperkinetic oral movements increase saliva production.3 Other causes include habitual finger-chewing, dental decay, gastro-oesophageal reflux and drugs (particularly nitrazepam, often used for seizures). Where possible, these issues should be addressed before embarking on specific treatments for the sialorrhoea, otherwise success is unlikely. If the child requires nitrazepam for seizure control, there is not much we can do except to warn the family that interventions for saliva control are unlikely to control the problem completely, although they may still be worthwhile. If dental caries are found on examination, a referral for dental care should be the first step before any specific measures are undertaken for the saliva. With regard to reflux, there is a randomized controlled trial of cisapride and ranitidine therapy in children with drooling and proven reflux oesophagitis23 that did not show any benefit for the drooling. Whether more modern drug treatments (specifically, proton pump inhibitors) would be beneficial is unknown, and there are anecdotal reports of reflux surgery (fundoplication) curing drooling that had been refractory to other measures.18
Antiepileptic Drugs in Children
Stanley R. Resor, Henn Kutt in The Medical Treatment of Epilepsy, 2020
The benzodiazepines are safe but aggravating to administer because of the high frequency of adverse effects. Allergic reactions are rare in children as in adults. Sedation, irritability, and signs of inebriation are common. In young children hypersalivation with drooling is a frequent nuisance. High doses of CZP and NZP have been associated with increased seizure frequency (10,11). Levels of CZP above 70 ng/ml can cause absence or minor motor status. The differences in toxicity between CZP and clorazepate seem to relate to differences in potency. DZP has a low antiepileptic therapeutic index and is not recommended for chronic antiepileptic treatment in children.
Intoxication as a Risk Factor
Burkhard Madea in Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
Pharmaceutical drugs may also be important in positional asphyxia by attenuating the genioglossal tone and/or by affecting other systems important for airway patency. The pedunculopontine tegmental nucleus has been identified as an important control centre for the regulation of upper airway muscle tone. In a study in rats, Saponjic et al. [37] showed that N-methyl-D-aspartate (NMDA) and NMDA antagonists introduced specifically into this nucleus could activate and block, respectively, the genioglossus muscle tone. In addition to these electromyogram recordings, they showed that the same treatments to some extent also modulated the breathing pattern. Similar experiments focusing on the role of the retrotrapezoid nucleus and the Kölliker-Fuse nucleus in the brain stem on the respiratory pattern and the tone of the upper airway muscles were performed by Silva et al. [40]. They found that NMDA injection into the retrotrapezoid nucleus of NMDA increased diaphragm and genioglossus muscle activities and that this response to NMDA stimulation or by hypercapnia was reduced after injection of the γ-aminobutyric acid GABAA agonist muscimol into the Kölliker-Fuse nucleus. These publications and other experimental studies provide support for the observation that NMDA antagonists, such as tramadol, methadone, ketamine and dextrometorphane, as well as GABA agonists (e.g. alcohols, benzodiazepines, chlormezanone and carbamates) can compromise the breathing at variable blood concentrations, depending on their receptor specificity, affinity and efficacy. In addition, certain drugs, such as the antipsychotic drug clozapine, can also cause hypersalivation [31]. A person who has adopted an abnormal, yet supine position, and is either comatose or immobilized, may aspirate saliva, and if a drug-induced hypersalivation is present, the amounts may be sufficient to compromise the airway flow and contribute to the asphyxia.
A critical review of incobotulinumtoxinA in the treatment of chronic sialorrhea in pediatric patients
Published in Expert Review of Neurotherapeutics, 2021
Wolfgang H. Jost, Armin Steffen, Steffen Berweck
Sialorrhea, also known as hypersalivation, ptyalis, or drooling, is excessive saliva beyond the lip margin, associated with neurological disorders or localized anatomical abnormalities in the oral cavity that inhibit complete closure of the laryngeal inlet [1,2]. Sialorrhea can be classified as anterior or dorsal pooling; anterior sialorrhea is the salivary incontinence or involuntary spillage of saliva over the lower lip that manifests as drooling, whereas dorsal sialorrhea is the flowing of saliva from the tongue to the pharynx [3]. Drooling is common in normally developing infants, but is generally considered pathologic after 4 years of age [4–6]. The most common cause of sialorrhea in children is cerebral palsy [7,8]; less common neurological disorders frequently associated with sialorrhea in children include Dravet, Rett, Goldenhar, and Angelman syndromes [9]. In addition, malformations and traumatic defects can cause a lack of integrity of the mouth and jaw region, resulting in sialorrhea [10].
Understanding and managing respiratory infections in children and young adults with neurological impairment
Published in Expert Review of Respiratory Medicine, 2023
Marijke Proesmans, Francois Vermeulen, Mieke Boon
Drooling and/or hypersalivation is a common problem in the NI patient population and is related to ineffective swallowing. While anterior drooling may not be associated with increased risk of aspiration (although it could also indicate ineffective swallowing?), posterior drooling may carry a higher risk for aspiration but it is more difficult to assess. Drooling may be decreased by medication such as glycopyrrolate [24]. Although relatively safe, main side effects are constipation, dry mouth or thickened secretions (which may lead to mucus plugging) and urinary retention. Moreover, it has a short half life time and thus should be given several times a day [25]. Scopolamine transdermal patches have a longer half-life and are an alternative to diminish the severity of drooling. Again, studies on their effectiveness in the population discussed here is limited. In a retrospective study in 44 children with non-progressive neurodevelopmental disability scopolamine patches significantly decreased drooling as well as drooling related complaints such as choking [26].
Effectiveness of clozapine on quality of life and functioning in patients with treatment-resistant schizophrenia
Published in Nordic Journal of Psychiatry, 2021
Meha Verma, Sandeep Grover, Subho Chakrabarti
In terms of clozapine specific side effects, almost all patients experienced constipation (98.07%) during clozapine therapy. About three-fifth reported experiencing hypersalivation (59.61%), and one-third reported sedation (32.69%). Tachycardia (9.61%) was noted in about one-tenth of the patients. Other side effects which were seen in few participants included leukocytosis (3.84%), eosinophilia (3.84%), hypotension (3.84%) and urinary incontinence (3.84%). The pharmacological intervention was required for hypersalivation (13.46%), and this was followed by pharmacological intervention for constipation (11.53%).
Related Knowledge Centers
- Dysphagia
- Vomiting
- Nausea
- Gastroparesis
- Pregnancy
- Saliva
- Drooling
- Rabies
- Pellagra
- Gastroesophageal Reflux Disease