Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide

Introduction and current guidance

Sialorrhoea (chronic pathological drooling) may present in children and young people with a neurological disorder, such as cerebral palsy. Chronic drooling is the unintentional loss of saliva from the mouth. Although drooling is normal in infants, it usually stops by 15 to 18 months, and is considered pathological if it is present after 4 years (Zeller et al. 2012a). Drooling can result in perioral chapping, irritation, maceration and secondary infection of the skin. The prevalence of moderate-to-severe drooling in children, young people and adults with neurological conditions, particularly cerebral palsy, is estimated to be between 10% and 37% (Zeller et al. 2012a; Mier et al. 2000).

The NICE guideline on cerebral palsy in under 25s recommends considering anticholinergic medication to reduce the severity and frequency of drooling in children and young people with cerebral palsy. The guideline recommends glycopyrronium bromide (oral or by enteral tube), transdermal hyoscine hydrobromide or trihexyphenidyl hydrochloride (for children with dyskinetic cerebral palsy, but only with input from specialist services).