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Published on: August 25, 2014
Consensus statement on the need for a specialist service for paediatric saliva control in neurodevelopmental
Charlie Fairhurst1, Belinda Crowe2, Katherine Martin3
1Paediatric Neurosciences, Evelina London Children's Hospital, London, UK charlie.fairhurst@gstt.nhs.uk.
Insights
Sialorrhoea, or poor saliva control, significantly burdens children with neurodevelopmental disabilities. This study outlines recommendations for specialist clinics to improve management of this condition in paediatric patients.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Sialorrhoea (poor saliva control) significantly impacts paediatric patients with neurodevelopmental disabilities, causing physical and psychological issues.
- Up to 44% of paediatric patients with cerebral palsy experience sialorrhoea, yet coordinated NHS specialist clinic pathways are lacking.
Purpose of the Study:
- To address the unmet need for equitable service delivery for paediatric sialorrhoea.
- To establish recommendations for specialist clinic management based on current literature and expert guidelines.
Main Methods:
- A specialist interest group convened to review existing literature and guidelines.
- Recommendations were formulated for equitable service delivery in specialist settings.
Main Results:
- Current management strategies for sialorrhoea include conservative measures, medications, botulinum toxin injections, and surgery.
- While effective, medications have adverse effects, and invasive procedures require specialist clinics.
- The specialist interest group developed agreed-upon recommendations for service delivery.
Conclusions:
- There is a critical need for coordinated specialist services for paediatric sialorrhoea.
- The developed recommendations aim to standardize and improve care for children with neurodevelopmental disabilities and sialorrhoea.
Abstract:
Poor saliva control (sialorrhoea) represents a considerable burden to paediatric patients with neurodevelopmental disabilities, contributing significantly to both physical and psychological problems. Despite a significant proportion of paediatric patients with cerebral palsy (up to ~44%) and other neurological conditions suffering from sialorrhoea, no coordinated pathways for specialist clinics exist on a formal basis within the NHS.Several management strategies exist, ranging from conservative measures, enteral and transdermal medications, intraglandular botulinum toxin injections through to glandular and/or ductal surgery. Anti-cholinergic medications such as glycopyrronium bromide and transdermal hyoscine hydrobromide are effective but have frequent adverse effects, meaning they are unsuitable or contraindicated in some patients. More invasive procedures, such as intraglandular botulinum toxin injections and surgical interventions, are highly effective but require specialist clinics in a controlled setting.Therefore, a specialist interest group was set up to agree recommendations for equitable service delivery in line with current literature and recommendations from the National Institute for Health and Care Excellence and the American Academy for Cerebral Palsy and Developmental Medicine in order to address this current unmet need. The results of these recommendations are reported here.
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