Saliva management in cerebral palsy

Drooling, dribbling or build up of saliva in the mouth is a common symptom for people with a range of neurological conditions, including Cerebral Palsy (CP).

In CP, drooling is usually related to:

• Swallowing problems
• Difficulties moving saliva from the front of the mouth to the throat
• Poor mouth closure
• Jaw instability
• Tongue thrusting

Drooling can cause or contribute to the following problems:

• Skin around the mouth, chin and neck becoming red and sore.
• Dehydration 
• Problems with eating and drinking
• Risk of chest infections and choking

There are different strategies to help with saliva management. Everyone is different so you may need to experiment with these. Always speak to your speech therapist or GP if you have any concerns over your swallowing or drooling.

Remember to swallow

Do try to remember to swallow every so often to clear the saliva from your mouth. You might want to set a reminder or alarm on your phone or download an app such as ‘Swallow Prompt’ to help.

Optimising your posture

Adopting a good posture can help to prevent saliva escaping from the mouth. Try to sit upright with a straight neck and back.

You might need advice around seating and positioning from an Occupational Therapist or Physiotherapist if your posture has changed.

Try to keep your mouth closed when you are reading or watching television to prevent saliva from escaping from the mouth.

Natural Products may help

• Dark grape juice can help to minimise saliva production.
• Pineapple or papaya juice or fruit might also work to reduce saliva.
• Sage capsules, tablets or powder may help and are available in most health food shops, or you could try making a tea from the dried herb.
• Ginger can be bought as a tea or you could try sucking on dried ginger if you feel this would be safe for your swallow.
• Chewing gum or sucking on a sugar free boiled sweet will help to draw the saliva back in your mouth for swallowing. Only try this if it is safe for you to try gum or sweets.

Minor Adaptations

• You may find it useful to use a waterproof insert discreetly paced between layers of clothes to prevent wetness on the skin.
• Try wearing a scarf made of absorbent material: fleece or one lined with towelling.
• Keep some tissues or a handkerchief with you to dab away any saliva around your mouth. Do try to dab rather than wipe to avoid irritating your skin further.
• Wearing a towelling wrist band might be easier to dab away saliva for you if using tissues is difficult.
• Placing an absorbent cloth between your pillow and pillow case can be helpful for night time drooling.
• Vaseline or lip balm can prevent your lips and corners of your mouth becoming sore.

Things to avoid

• Acidic fruits and juices like orange or chewy sweets can increase salvia production.
• Alcohol can stimulate saliva production so be aware of this if you do drink alcohol, consider switching your mouthwash to an alcohol free version too.

Further help

If none of these strategies are helpful there is a variety of other options to try:

• Exercises to help with muscle strength and tone if the lips are weak or to help with sensory awareness.
• Medication to dry the mouth/reduce saliva production such as hyoscine patches or Glycopyrronium bromide.
• Botulinum toxin of the saliva glands.
• In some rare cases surgery or radiotherapy to the saliva glands may be considered.

If you have any concerns always speak to your Speech therapist or CP team.