Is the drool from salivary secretions? Is the drool from allergies? Is the drool actually refluxed food? Is the drool not really a drool problem, but actually a tone issue? There are lots of things that lead to what can be considered a drooling problem. Below we will discuss each of these different types of drooling. Before we get into details however, please note that we are NOT doctors. Many of the suggested treatments and medications have side effects. Before taking any medication please consult with your doctor.
Salivary secretions are pretty common with kids that have special needs. There are a few different approaches that are generally considered. There is a medication called Glycopyrrolate or Robinul. This medication will thicken the secretions. For some children this makes it easier to then swallow or cough up. If thickening does not work, there is a patch called Scopalomine. Using the patch for drool is an off label treatment; the patch is intended for sea sickness. The patch will work to dry out the secretions much like an Antihistamine or Diphenhydramine such as Benadryl which are also often used to help dry out secretions. If the medications help, but you need more there are more aggressive treatments as well. Some people have had a lot of success using Botox in the salivary glands. The injections of Botox into the glands can be uncomfortable/painful and requires the child to be very still. Typically the doctor doing the injections will require some form of sedation. There are 2 larger and 2 smaller salivary glands. A doctor may need to do a few rounds of Botox to determine which glands are most active as well as the amount of Botox needed to make a difference. A Botox injections last a few months, this is not a permanent solution. If Botox works well, a doctor may want to remove the salivary gland all together. This is a surgical procedure, but some people opt to so the larger procedure once as opposed to getting Botox every few months. Before a doctor is willing to do this surgery, they typically want to start with at least a few rounds of Botox.
If drooling is determined to be a result of allergies there are a few options to consider. You can try things like Antihistamines or Diphenhydramines. There are Guaifenesin (Mucinex). There are many nasal sprays, nasal steroids, and breathing treatments that can be used to help with allergies as well. You may consider trying a vaporizor or a humidifer. If allergies are an issue there are many hypoallergenic products as well including bed linens, cleaning products, clothing and much more.
Many children with special needs have reflux. It is easy for frequent reflux to be confused with salivary secretions. Being that there is always saliva in the mouth, it can be hard to determine the difference. Usually doctors will suggest treating salivary secretions first (unless the child has known and/or sever reflux issues). If the treatment is unsuccessful the doctor may then look into reflux as the source. There are many medications available to aid with reflux (some over the counter, some prescription) your doctor can help determine the best one. Just like other medications, it may take a few to figure out what will work and how much/often you need it. In the case of severe reflux a doctor may recommend a more invasive procedure called a Nissen Fundoplication often referred to as a Fundo or Nissen. This procedure will tighten the sphincter making it much more difficult for stomach contents to go back up the esophagus. Many people that get this procedure expect that nothing will be able to pass the fundo. Depending on how tight the fundo is wrapped, it may still be possible for a child to reflux/throw up after the procedure. There are tests to determine if the fundo is in tact, but it is not unheard of. If your child has a fundo and continues (or later begins) to throw up, be sure to let your doctor know. They will most likely want to run an Upper GI or at least get some xrays.
For children with tone issues (rigid, dystonia or spastic) drooling may be a much different cause. For children that are not able to control muscle movement, they may flex muscles along the throat, abdomen, or even their tongue and jaw leading to increased reflux and/or salivary secretions. Typically all of the above treatments are considered, but depending on the tone of the child some of these treatments may not make much of a difference. In addition to treating the secretions, there are medications and treatments used to help with tone. A common medication used is Baclofen. Baclofen can be given in many different ways. Usually it will start out as an oral/gtube medication or sometimes it can be given under the tongue. If there are good results with Baclofen a pump can be placed into the spine to administer it directly into the nervous system. There are many other medications on and off label that doctors may suggest to help with tone. Sometimes anti seizure medications are used. Sometimes doctors will try anxiety medications (clonazepam, diazapam. ect.). Sometimes you may have a muscle relaxer such as Dantrium suggested. In cases where a child flexes the throat muscles a lot, a doctor may suggest tracheostomy tube to bypass the mouth all together.
This article begins to break down some of the common causes and treatments for drooling. However, there are many more out there. If you have any information you would like to add please feel free to comment and/or email us. And again, we are not doctors. Please consult with your doctor before trying any of the treatments discussed above.