Problemi speciali
La scialorrea nel bambino disabile: un vademecum per il pediatra
Sialorrhea in Children with Disabilities: A guide for PAediatricians
Valeria Caspani1, Roberta Onesimo2, Angelo Selicorni3
1Scuola di Specializzazione in Pediatria, Università dell’Insubria, Varese
2UOC di Pediatria Generale, Fondazione Policlinico “A. Gemelli” IRCCS, Roma
3SC di Pediatria, Centro Fondazione Mariani per il Bambino Fragile, ASST Lariana, Como
Giugno 2026 - pagg. 368 -374 | DOI: 10.53126/MEB45368
Abstract
Sialorrhea, the involuntary loss of saliva, is a frequent and easily detectable symptom in children with disabilities and neurodevelopmental disorders, with prevalence estimates ranging from 10-58% in cerebral palsy and up to 60% across neurodevelopmental conditions. This vademecum for the paediatrician reviews epidemiology, pathophysiology and clinical consequences, distinguishing anterior sialorrhea (with relational, dermatological and psychosocial impact) from posterior sialorrhea (linked to salivary aspiration and recurrent, sometimes fatal, pneumonia). Diagnosis is essentially clinical, supported instrumentally by FEES or videofluoroscopy for posterior forms, while quantification relies on quick parent-administered scales and questionnaires, most commonly the qualitative Drooling Impact Scale (DIS). Management options are rehabilitative (behavioural therapy, biofeedback, oral-motor therapy guided by speech therapists and family compliance), pharmacological (anticholinergics, with glycopyrrolate syrup now preferred over atropine, benztropine and scopolamine for its favourable safety profile and poor blood-brain barrier penetration) and surgical. A complementary, multimodal therapeutic approach is recommended, especially in children, as illustrated by a clinical case of an 11-year-old girl with ZTTK syndrome (de novo SON variant) managed with tailored glycopyrrolate dosing.
Riassunto
La scialorrea, ovvero la perdita involontaria di saliva, e un sintomo frequente e facilmente rilevabile nel bambino con disabilita e disturbi del neurosviluppo, con prevalenza stimata dal 10-58% nella paralisi cerebrale infantile fino al 60% nei disturbi del neurosviluppo. L'articolo, un vademecum per il pediatra, ne analizza epidemiologia, fisiopatologia e conseguenze cliniche, distinguendo la forma anteriore (con impatto relazionale, cutaneo e psicosociale) dalla forma posteriore (associata ad aspirazioni salivari e polmoniti ricorrenti, talvolta letali). La diagnosi e prevalentemente anamnestico-clinica, integrata nelle forme posteriori da studio strumentale della deglutizione (FEES o videofluoroscopia), mentre la quantificazione si avvale di scale e questionari di rapida somministrazione ai genitori, in particolare la Drooling Impact Scale (DIS). Le opzioni terapeutiche sono riabilitative (terapia comportamentale, biofeedback, oral-motor therapy, con ruolo chiave del logopedista e della compliance familiare), farmacologiche (anticolinergici, con il glicopirrolato sciroppo oggi preferito ad atropina, benzotropina e scopolamina per il buon profilo di sicurezza e la scarsa penetrazione della barriera emato-encefalica) e chirurgiche. Si raccomanda un approccio complementare, illustrato dal caso di una bambina di 11 anni con sindrome ZTTK (variante de novo del gene SON) gestita con dosaggio personalizzato di glicopirrolato.
Classificazione MeSH
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Corrispondenza: vcaspani@studenti.uninsubria.it