Drooling Impact Scale Research Articles

Ultrasound-guided botulinum toxin injections of salivary glands in cerebral palsy children with sialorrhea

Objective: Excessive salivation and drooling are distressing problems that affect both children and their families. Salivary gland botulinum toxin injection is a widely studied therapeutic method for treating sialorrhea. The proper protocol for such treatment modality is an area of interest for researchers. This study set out to assess the success of ultrasound-guided botulinum toxin injections in either the submandibular or combined with parotid salivary glands for children with cerebral palsy suffering from sialorrhea, while also identifying factors that predict a positive treatment outcome. Method: This cross-sectional study included 30 children with cerebral palsy who have Sialorrhea. Ultrasound-guided botulinum toxin injections of submandibular salivary glands alone or combined with parotid glands were done. Drooling was evaluated using Drooling Rating Scale, Drooling Impact Scale, and 5-minute Drooling Quotient. Children were followed up weekly for 12 weeks after botulinum toxin injections. Result: All children showed a significant decline in drooling and sufficient caregivers’ satisfaction for the first 8 weeks after botulinum toxin injections, with gradual worsening of drooling later in 60% of children. Assessment scores were significantly lower in those who received combined parotid and submandibular injections than those who received submandibular gland injections alone. Changes in drooling scores have a significant negative correlation with the severity of motor disabilities. Conclusion: Submandibular salivary gland injection alone has a satisfactory response in decreasing drooling in children with cerebral palsy. However, a combined injection of both parotid and submandibular salivary glands gives a better response for at least 8 weeks without complications. This study not only addresses the clinical effectiveness of botulinum toxin injections in managing sialorrhea in children with cerebral palsy but also opens avenues for improved dietary strategies. Keywords: botulinum toxin; salivary gland; sialorrhea; cerebral palsy

Glycopyrronium 320 μg/mL in children and adolescents with severe sialorrhoea and neurodisabilities: A randomized, double-blind, placebo-controlled trial.

To investigate the efficacy, safety, and impact on quality of life (QoL)of an oral formulation of 320 μg/mL glycopyrronium designed for children. A double-blind, placebo-controlled SALIVA (Sialanar plus orAl rehabiLitation against placebo plus oral rehabilitation for chIldren and adolescents with seVere sialorrhoeA and neurodisabilities) trial was conducted. Children (3-17 years) with neurodisabilities and severe sialorrhoea (modified Teachers Drooling Scale ≥6) were randomized to 320 μg/mL glycopyrronium or placebo, in addition to non-pharmacological standard care. Of 87 participants, 44 were aged 10 years or under and 43 had cerebral palsy. The primary endpoint, change in total Drooling Impact Scale (DIS) score from baseline to day 84, was significantly greater (improved) with 320 μg/mL glycopyrronium versus placebo (median [quartile 1, quartile 3] -29.5 [-44.5, 0] vs -1 [-16, 5]; p < 0.001), an effect also observed at day 28 (median - 25 vs -2; p < 0.01). Significant reduction in bibs/clothes used per day was seen with glycopyrronium versus placebo at day 84 (median - 2 vs 0; p < 0.01). Glycopyrronium significantly improved DIS items 9 and 10 related to the extent that drooling affects the child's and family's life (p ≤ 0.03). Adverse events were reported by 77.3% and 69.8% of children with glycopyrronium and placebo respectively; the most common treatment-related adverse event was constipation (20.5% and 16.3%). The formulation of 320 μg/mL glycopyrronium significantly improved drooling and reduced its impact on QoL, with good tolerability in children with neurodisabilities. The formulation of 320 μg/mL glycopyrronium significantly improved Drooling Impact Scale score versus placebo at day 84. The formulation reduced the impact of drooling on the child's and family's quality of life. There were no safety or tolerability concerns with this specific formulation.

Oromotor rehabilitation on drooling and feeding activities in children with cerebral palsy: A case study

Abstract: Cerebral palsy (CP) is a neurological disorder that affects the brain and causes difficulties with muscle coordination, body movement, and balance. Children with CP frequently present with severe oral motor impairments. Children with CP suffer from a variety of motor disorders, which are frequently accompanied by sensory, cognitive, communication, perception, and behavioral disorders, as well as epilepsy, nutrition, dysphagia, and oral motor dysfunction. CP refers to a group of long-term movement and posture impairments that occur in the developing infant brain, limiting many activities such as independent walking, stair climbing, running, or walking on an uneven surface. The purpose of this case report is to describe the difficulty in oromotor functional activity experienced by a CP child. A 5-year-10-month-old baby presented with drooling and difficulty in feeding activities, which greatly affected her day-to-day activities. Her pediatric Ability for Basic Feeding and Swallowing in Children-10 (ABFS-C) was 6/15 and The Drooling Impact Scale (DIS) 72/100 total score improved to (DIS) 83/100 and (ABFS-C) 10/15.

Comparative Efficacy and Side Effect Profiles of Interventions for Pediatric Saliva Control: A Cohort Study

To compare efficacy and side effect profile data on conservative, behavioral, pharmacological, and surgical treatments used for pediatric saliva control. A cohort study of children (n=483) referred to a specialty Saliva Control service between May 2014 and November 2019 was performed, using quantitative data from pretreatment and post-treatment questionnaires (the Drooling Impact Scale [DIS], Drooling Rating Scale [DRS]) and recording of side effects. Overall, 483 children were included; treatment choices were based on published international guidelines. The greatest improvement was seen after intraglandular botulinum toxin A (BTX-A) injections (n=207; 551 courses; mean DIS change, 34.7; 95% CI=29.2-35.7) or duct transpositional surgery (n=31; mean change in DIS, 29.0; 95% CI,22.3-35.7). Oral anticholinergics were associated with good outcomes, with no significant statistical difference between glycopyrronium bromide (n=150; mean DIS change, 21.5; 95% CI,19.1-24.0) or trihexyphenidyl (n=87; mean DIS change, 22.4; 95% CI,18.9-25.8). Inhaled ipratropium bromide was not as efficacious (n=80; mean DIS change, 11.1; 95% CI,8.9-13.3). Oromotor programs were used in a selected group with reliable outcomes (n=9; mean DIS change, 13.0). Side effects were consistent with previous studies. Overall, in cases of milder severity, enterally administered therapies provided a good first-line option. With more severe problems, BTX-A injections or saliva duct transpositional surgery were more effective and well tolerated. We describe a large, single-center pediatric saliva control cohort, providing direct comparison of the efficacy and side effect profiles for all available interventions and inform clinical practice for specialists when considering different options. BTX-A injections or saliva duct transpositional surgery seem to be more effective for saliva control that is more severe.

Evaluation of the synergistic effect of physiotherapy and preventive dental treatment on drooling in children with special healthcare needs

Drooling is the involuntary, passive spillage of saliva due to inability to handle oral secretions, normally occurring in infants and young children. It is considered abnormal to have problems with saliva control beyond the age of 4 years. Physiotherapy treatment including oral motor stimulation has been regularly used to decrease drooling but its effect along with dental treatment is unknown. Therefore, the study was conducted with the combined effect of physiotherapy and dental treatment on drooling in children with developmental disorders. A study with pre-post intervention experimental design was conducted to study the combined effect of physiotherapy and dental treatment. Ten children with developmental disorders in the age group of 4-12 years with a complaint of drooling were recruited from the pediatric out-patients department and child developmental centre of a tertiary care hospital and a special school in Belagavi, India. Pre interventions outcomes for drooling severity through 5-minute drooling quotient scale, impact of drooling through drooling impact scale and oral hygiene status through OHIS index were noted. Children were subjected to dental intervention consisting of oral prophylaxis and fluoride application followed by physiotherapy intervention consisting of oral motor stimulation thrice a week for 4 weeks. Data was analyzed using descriptive analysis. The results indicated a significant improvement in drooling with a mean difference of 11.20±4.87 and p=0.001 on the drooling impact scale and mean difference of 23.66±6.07 and p=0.001 on the 5- minute drooling scale. It also indicated a significant improvement in plaque scores with the mean difference of 0.25±0.16 and p=0.001 (p&lt;0.05). This study showed that combination of physiotherapy and dental treatment is useful for the treatment of drooling in children with developmental disorders and shown that interdisciplinary approach is more effective in management of these children.

Randomised, double-blind, placebo-controlled trial of glycopyrronium in children and adolescents with severe sialorrhoea and neurodisabilities: protocol of the SALIVA trial

IntroductionSevere sialorrhoea is a common, distressing problem in children/adolescents with neurodisabilities, which has adverse health and social consequences. The SALIVA trial is designed to evaluate the efficacy and safety of...

Glycopyrrolate for drooling in children with medical complexity under three years of age

BackgroundThe aim of the study is to determine that Glycopirrolate is safe and effective in decreasing drooling in children with medical complexity under 3 years of age. Medical treatment is based on anticholinergic drugs as transdermal scopolamine, benzotropine and GLY. GLY (Glycopyrronium bromide) is a synthetic quaternary ammonium anticholinergic agent with poor blood–brain barrier penetration and consequently has limited central effects. Actually, the oral GLY formulation was approved by the United States Food and Drug Administration (FDA) to treat drooling in children aged 3–16 years. Five studies reported on GLY use for the treatment of drooling in children with cerebral palsy and other conditions with neurological impairment; four are prospective studies while one a retrospective review.Methodsthis is a case report of eighteen children (sex ratio 11/8, median age 17 months, range 2–36 months) under three years of age, followed by a multidisciplinary team at the Bambino Gesù Children Hospital. The median follow-up was of 31.5 months (range 1–69 months). Response to treatment was assessed according to the Drooling Impact Scale administered at time 0 and after 1 month. All patients have an important neurological impairment: nine patients have a cerebral palsy (Gross Motor Function Classification System class V) and nine a genetic/malformative syndrome. Twelve patients have a tracheostomy and two need mechanical ventilation. Gastrostomy is present in 16 out of 18 patients. All patients received Glycopirrolate. The median starting daily dose was 0.065 mg/kg/die (range 0.02–0.21 mg/kg/die) three times a day. The drooling impact scale was administered at time O and after 1 month.ResultsFour out 18 patients stopped treatment for adverse event, lack of efficacy or parental decision. The mean Drooling Impact Scale at time 0 was 89 (range 81–100) and after 1 month 61(range 43–78); the difference was statistically significant (P < 0.001). The overall response to treatment was 94%.ConclusionsThis is the first study to determine the safety and effectiveness of Glycopyrrolate in decreasing drooling in a specific subset of patients. No major side effects were observed. Further comparative studies are needed to confirm our results.

Severity of sialorrhea and tracheal secretions in infants and toddlers with a tracheostomy with a focus on quality of life

ObjectiveSialorrhea and tracheal secretions can be present in patients with a tracheostomy. The current study seeks to survey the severity of sialorrhea and tracheal secretions in infants and toddlers with a tracheostomy, and to correlate this severity with quality of life. MethodsProspective cross-sectional survey pilot study: 26 patients (ages 0.33 years – 4.09 years) were given the Infant/Toddler Quality of Life Questionnaire Short Form 47, the Drooling Impact Scale and assessed for severity of tracheal secretions with a Tracheostomy Secretion Severity Scale. Spearman's correlation and Mann Whitney U tests were used to assess correlation between and contributors to quality of life, drooling severity, and tracheostomy secretion severity, number of outpatient visits, and respiratory related hospitalizations. ResultsAverage health perception quality of life was 46.7 and average parental impact quality of life was 58.85. The average for the Drooling Impact Scale overall was 19.7, for frequency 4.16, for severity 3.12 and for the Tracheostomy Secretion Severity Scale 2.4. There was strong correlation between the Drooling Impact Scale and the Tracheostomy Secretion Severity Scale (R = 0.432 p = 0.03) overall, and moderate correlation between Drooling Impact Scale and Tracheostomy Secretion Severity Scale (R = 0.39956 p = 0.047) frequency. There was no correlation between health perception quality of life or parental impact quality of life and Drooling Impact Scale or Tracheostomy Secretion Severity Scale. ConclusionDrooling severity does not have significant impacts on health perception and parental impact quality of life for infants and toddlers who have a tracheostomy. Overall drooling impact scores and drooling frequency are related to tracheostomy secretion severity.

Translation and validation of the drooling impact scale questionnaire into Brazilian Portuguese

IntroductionInadequate drooling can cause serious clinical, functional and social problems. Validated questionnaires to evaluate drooling impact on quality of life are lacking in Brazilian Portuguese. ObjectivesTo translate and validate the drooling impact scale to Brazilian Portuguese. MethodsThe drooling impact scale was translated to Brazilian Portuguese and back- translated to English to assess potential conceptual differences. Brazilian Portuguese version of drooling impact scale was applied to a 40 patients’ sample of sialorrhea presenting pediatric patients (up to 20 years of age). Chronbach’s alpha, exploratory factorial analysis and confirmatory factorial analysis were then proceeded with data collected. ResultsThe mean drooling impact scale value for the whole population was 51.77 (SD = 16.13). The internal consistency obtained with Cronbach’s alpha indicated a value of 0.72 for the entire sample. The Bartlett’s test of sphericity was significant (p < 0.0001), confirming correlation among variables tested. Kaiser-Meyer-Olkin measure of sampling adequacy revealed a value of 0.72, indicating that the correlation matrix was reasonably suitable for factor analysis. Regarding exploratory factorial analysis, parallel analysis suggested a two-factor solution that was used for confirmatory factorial analysis. The first factor was responsible for 33.78% of the variance with an Eigenvalue of 3.38. The second factor explained 16.1% of the variance with an Eigenvalue of 1.61. At confirmatory factorial analysis, the two-factor model showed consistently better adjustments parameters than the one-factor model. ConclusionThe drooling impact scale has been successfully translated to Brazilian Portuguese language, showing adequate internal validity. Validation of this instrument allows physicians and other personnel involved in the care of these patients to perform a better management of patients experiencing drooling. With this tool, we are now able to guide routines and provide guidelines both before and after the different kinds of treatments in order to improve the general well-being of the patient and his family.

Validity, reliability and responsiveness to change of the French version of the drooling impact scale

Background work still needs to be done to measure the impact of sialorrhea on quality of life and define the efficacy of different therapies. The Drooling Impact Scale showed good validity and sensitivity to change, especially after botulinum toxin injection. The aim of this study is to present its French translation and to explore its validity, reliability and responsiveness to change in a group of children with Cerebral Palsy. Methods multicentre study at six rehabilitation centres in France. Children with Cerebral Palsy aged 4–18 years with sialorrhea problems were included (n = 55), either in a control group (n = 33) or in the intervention group (n = 22, with 3 drug treatment and 19 botulinum toxin injections). The French Drooling Impact Scale was administered twice, 1 month apart. Results The French Drooling Impact Scale total score at inclusion was meanly 53.9 (Standard Deviation 11.9) in the stable control group and 66.0 (16.1) in the intervention group (p = 0.0058). The validity of the scale was established, as well as an adequate internal consistency (Cronbach’s α = 0.71); correlations between each item and the total score were found between 0.5 and 0.71 except for item 5 (r = 0.38) and item 7 (0.41). The test-retest reliability in stable children was good (Lin coefficient = 0.83, bias correction factor = 0.92 and Pearson correlation coefficient = 0.89). There was a high responsiveness to change, mean change was –40.0 in the intervention group and –3.6 in the stable group (p < 0.0001), with Standard Error of Measurement = 2.6. Conclusion the French Drooling Impact Scale has shown sufficient clinometric properties to be used now by clinicians or researchers. IMPLICATIONS FOR REHABILITATION The Drooling Impact scale has now its French version. The French version of the Drooling Impact Scale has shown its validity and a good test-retest reliability. The responsiveness to change was explored in a group of children undergoing saliva-control interventions and the scale was able to show a big change. The authors recommend to use this questionnaire in a semi-directed interview conducted by a health professional.

Turkish Validation of The Drooling Impact Scale

Turkish Validation of The Drooling Impact Scale

Validation of the French Version of the Drooling Impact Scale in a Pediatric Cerebral Palsy Population

Validation of the French Version of the Drooling Impact Scale in a Pediatric Cerebral Palsy Population

Effects of the neuromuscular bandage as rehabilitative treatment of patients with drooling and intellectual disability: an interventional study.

The aim of this work was to assess the effect of neurological bandages (Kinesio Taping) for managing saliva flow in patients with drooling and intellectual disability. Quasi-experimental study included 30 patients (20 male and 10 female participants) mean age of 15years with intellectual disability and drooling [Public Special Education Centre in Cartagena (Murcia, Spain)]. Treatment consisted of the application of a strip of neuromuscular bandage applied in the suprahyoid area for a 3-month period. Efficacy was assessed by means of three clinical scales: the Sialorrhea clinical scale, the drooling rating scale and the drooling impact scale. These evaluations were performed at baseline, after 1 and 3months of intervention. Clinical improvements were obtained, showing statistically significant reductions in drooling after 1month (P<0.001) and 3months (P<0.001). The application of neuromuscular bandages in the suprahyoid muscle area can be a useful option for managing drooling in patients with intellectual disability.

Can muscle vibration be the future in the treatment of cerebral palsy-related drooling? A feasibility study.

Background: Drooling is an involuntary loss of saliva from the mouth, and it is a common problem for children with cerebral palsy (CP). The treatment may be pharmacological, surgical, or speech-related. Repeated Muscle Vibration (rMV) is a proprioceptive impulse that activates fibers Ia reaching the somatosensory and motor cortex. Aim: The aim of the study is to evaluate the effectiveness of rMV in the treatment of drooling in CP. Design, setting and population: This was a rater blinded prospective feasibility study, performed at the “Gli Angeli di Padre Pio” Foundation, Rehabilitation Centers (Foggia, Italy), involving twenty-two CP patients affected by drooling (aged 5-15, mean 9,28 ± 3,62). Children were evaluated at baseline (T0), 10 days (T1), 1 month (T2) and 3 months (T3) after the treatment. Methods: The degree and impact of drooling was assessed by using the Drooling Impact Scale (DIS), the Drooling Frequency and Severity Scale (DFSS), Visual Analogue Scale (VAS) and Drooling Quotient (DQ). An rMV stimulus under the chin symphysis was applied with a 30 min protocol for 3 consecutive days. Results: The statistical analysis shows that DIS, DFSS, VAS, DQ improved with significant differences in the multiple comparisons between T1 vs T2, T1 vs T3 and T1 vs T4 (p≤0.001). Conclusion This study demonstrates that rMV might be a safe and effective tool in reducing drooling in patients with CP. The vibrations can improve the swallowing mechanisms and favor the acquisition of the maturity of the oral motor control in children with CP.

Onabotulinum Toxin A Injections Into the Salivary Glands for Spinal Muscle Atrophy Type I: A Prospective Case Series of 4 Patients.

The aim of the study was to investigate the safety and efficacy of onabotulinum toxin A injection to the salivary glands under ultrasound guidance for the treatment of sialorrhea in patients with spinal muscular atrophy type I. Prospective case series with four patients with spinal muscular atrophy type I who received onabotulinum toxin A injection to parotid and submandibular glands for sialorrhea as part of clinical care. All four patients received validated surveys for measuring drooling, including objective measures of number of bib changes, and number of mouth wipes before injection and 4-6 wks after injection. Research was limited to survey completion. Scales included the Drooling Severity and Frequency Scale and the Drooling Impact Scale as well as a new scale used in our clinic, the Posterior Drooling Scales looking at coughing/choking and number of aspiration pneumonias. There were no adverse events. All four patients showed clinically significant improvements. The improvement in drooling using the Drooling Impact Scale was statistically significant (paired t test, t = 3.243, P = 0.048). All patients improved with number of mouth wipes. Ultrasound-guided onabotulinum toxin A injections to the salivary glands may be a safe and effective method of decreasing drooling in patients with spinal muscular atrophy type I.

EFFECTIVENESS OF KINESIO TAPING WITH OROMOTOR EXERCISES IN IMPROVING DROOLING AMONG CHILDREN WITH CEREBRAL PALSY

Objective: To determine the effectiveness of kinesio taping (KT) with oromotor exercises (OME) in improving drooling in children with cerebral palsy. Material and Methods: A randomized control trial (RCT) was conducted at National Institute of Rehabilitation Medicine (NIRM). Forty eight CP children, age ranged 4-8 years, having good head control and fair comprehension for verbal commands with drooling severity ≥ 3 rated on Thomas Stonells drooling scale were included in the study. The n=48 CP children were equally divided into two groups. Group A (n=24) participants were given an hour time which included taping of orbicularis oris muscle followed by oral motor exercises. Group B (n=24) participants were given the same treatment except there was only application of Kinesio taping of orbicularis oris muscle without oral motor exercises. The participants were assessed 5 times; at week 0 (Baseline) and then during intervention at week 4, week 8, week 12 and finally at week 16 after completion of intervention. Data was collected through Thomas Stonells drooling scale and drooling impact scale. Data was analyzed by using SPSS version 21. For presentation of categorical and demographic variables, mean and standard deviation were used. RM-ANOVA was used to analyze changes within the groups and independent samples t-test was used for differences between the groups. Results: The mean age in group A is 3.93±1.7 years and the mean age in group B is 3.66±1.26 years. The result showed significant improvement within both groups (p≤0.05). Between groups comparison revealed more significant decrease in drooling severity and its impact in group A (KT+OME) as compared to group B (KT) at p≤0.05. in case drooling frequency no significant difference was observed. Conclusion: The results of the study indicated that kinesio tapping along with oro-motor exercises were more effective management option for drooling severity and impact on CP children life. Keywords: Cerebral palsy, drooling, kinesio tapping, oro-motor exercises, Thomas Stonells drooling scale, drooling impact scale.

Drooling Reduction Intervention randomised trial (DRI): comparing the efficacy and acceptability of hyoscine patches and glycopyrronium liquid on drooling in children with neurodisability

ObjectiveInvestigate whether hyoscine patch or glycopyrronium liquid is more effective and acceptable to treat drooling in children with neurodisability.DesignMulticentre, single-blind, randomised controlled trial.SettingRecruitment through neurodisability teams; treatment by parents.ParticipantsNinety children...

Treatment of drooling with sublingual atropine sulfate in children and adolescents with cerebral palsy.

To report the effect of sublingual atropine sulfate to treat drooling in children with cerebral palsy by comparing the results of the Drooling Impact Scale in a non-controlled open clinical trial. Twenty-five children were assessed. The difference in the mean scores of the pre- and post-treatment scales reached statistical significance. There was a low frequency of side effects compared to studies with other anticholinergics. The use of sublingual atropine sulfate seems to be safe and there is a reduction in the Drooling Impact Scale score, which suggests efficacy in the treatment of drooling in children and adolescents with cerebral palsy. Our results should be replicated in randomized, placebo-controlled studies with larger numbers of participants.

Drooling in Patients with Cerebral Palsy: The Effectiveness of Botulinum Toxin A Treatment

Background . Drooling (sialorrhea) is a complex medical and social problem of patients with cerebral palsy (CP). During the last decade many methods for drooling correction in CP are under active development. Aim : to evaluate the effectiveness and safety of the first and repeated injections of botulinum toxin A (BTA) for correcting drooling in children with CP. Methods. 13 children (2 years — 14 years 7 months) with spastic forms of CP and drooling resistant to non-drug treatment. Drooling was evaluated with the Drooling Impact Scale — DIS before, 1, 3 and 6 months after the BTA injections. Parotid and submandibular salivary glands were injected under ultrasound control with Dysport — 1 group (5 children) or Botox — 2 group (8 children). The total dose of Dysport for the all glands was 120–320 U (3,8–14,5 U/kg), Botox — 30–100 U (2,5–4,5 U/kg). The median of the basic DIS index was 77 (64–90) points in the first group and 58 (53–66) points in the second group. Results. One month after the BTA injections the DIS index decreased by 20 and more points in 6 (42,2%) patients, by 10–19 points in 7 (53,8%) children. There were no persistent side effects and no difference in the BTA effectiveness between the two groups. The mean decrease of DIS was 30% in both groups. 3 months after the injections 2 patients (15,4%) kept 20 points decrease of the DIS index, 6 patients (46,2%) demonstrated 10 points decrease. 6 months after injections nearly all patients returned to the basic level of drooling. Repeated injections of the BTA demonstrated the same tendency and duration of the DIS changes. There was no significant correlation between the GMFCS level and the drooling intensity. Conclusion. BTA injections into salivary glands of children with CP was an effective and safe method of drooling correction with the maximum effect taking place 2–4 weeks after the injections and a stable effect — 3 months after the injections.

Secondary Effects of Botulinum Toxin Injections Into Salivary Glands for the Management of Pediatric Drooling

This study aimed to assess the secondary benefits and adverse effects of botulinum toxin A injections into the parotid and submandibular glands in children with developmental disability and to determine whether these effects are related to reduction in drooling. Twenty-six children were injected (14 boys and 12 girls; mean age, 11 years 3 months). The Drooling Impact Scale and a secondary effects questionnaire covering aspects of eating, speech, saliva management, and sleep, were administered to the main carer at specific times before and after injection. Group mean preinjection and postinjection item and domain scores were compared using paired t tests. Change scores were calculated; individually categorized as improvement, no change, or deterioration; and related to change in drooling scores using linear regression analysis. Over 4 weeks, evidence of improvement was seen for the entire group with respect to drooling (P < 0.001), eating (P = 0.05), speech (P = 0.04), and sleep (P = 0.01), but not saliva management. Conversely, a minority of families reported worsening of eating skills after the injections that was directly related to lack of improvement in drooling. Because a minority of children unpredictably experience temporary adverse effects after botulinum toxin A injections into the salivary glands, swallowing function and nutritional status should be taken into account before proceeding with treatment.