Spanish consensus statement on the diagnosis and treatment of sialorrhoea in children with cerebral palsy

INTRODUCTION: Anterior sialorrhoea, or "drooling," is the involuntary loss of saliva due to an inability to manage oral secretions. In cerebral palsy (CP), drooling results from oral motor dysfunction, significantly impacting the quality of life of both patients and their caregivers. Despite its physical and psychological repercussions, the clinical approach to sialorrhoea remains poorly defined. OBJECTIVES: This document aims to provide a guideline for the evaluation and management of sialorrhoea in children with CP, based on the best available evidence and expert consensus. Additionally, it seeks to identify gaps in the literature and propose future research directions. METHODOLOGY: A working group was formed, composed of paediatric neurologists from the Spanish Society of Paediatric Neurology (SENEP). A systematic review of the literature was conducted in databases such as MEDLINE, PubMed, and Cochrane, prioritising randomised clinical trials and systematic reviews. Clinical evidence was included when higher-level evidence was unavailable, and recommendations were formulated based on expert consensus. CONSENSUS AND DISCUSSION: The management of sialorrhoea should be multidisciplinary, including thorough clinical evaluations and assessment scales for severity and impact. Treatment should follow a stepwise approach, starting with non-pharmacological strategies (oromotor therapy, postural correction) and, if necessary, pharmacological interventions with anticholinergics (glycopyrrolate, trihexyphenidyl) or botulinum toxin injection. Surgical options and radiotherapy are reserved for refractory cases. CONCLUSION: Sialorrhoea is a clinically relevant issue in children with CP, requiring an individualised approach based on the best available evidence. This consensus provides a useful guideline for clinical practice and highlights the need for further studies to optimise treatment.