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.