12 GENERAL INTRODUCTION GENERAL INTRODUCTION Drooling is defined as the unintentional loss of saliva and other oral contents from the mouth and could be pathological when it persists after the age of 4 years.1, 2 Drooling is a common problem in children with neurodevelopmental disabilities like cerebral palsy (CP). Seventy-eight percent with neurodevelopmental disabilities may have complaints of drooling, with a mean prevalence of 44%.3-7 The prevalence of CP has increased over the past decades and is currently approximately 2 to 2.5 per 1,000 live births worldwide.8-10 But, children with various other neurodisabilities can suffer from drooling as well.11 When treating patients with neurodisabilities, drooling as a problem is easily ignored or overlooked in the wide variety of impairments these individuals are confronted with. Yet, drooling is a disabling condition that leads to both emotional and physical distress: many children consider it their worst condition when it comes to social interaction and relationships.12 The image, odour, and spray of saliva while speaking or coughing can lead to social isolation. Drooling is stigmatizing and leads to intellectual underestimation, which interferes with social integration.13, 14 Drooling patients receive fewer affectionate gestures like attention, hugs, and kisses which can lead to low self-esteem.13, 15-18 Depending on their cognitive and intellectual level, children may be very aware of this.15 Moreover, children who are conscious of drooling interact less with peers.12, 19-21 Drooling does not solely affect the child. Parents or carers suffer practical implications as daily care includes frequently reminding children to swallow pooled saliva, repeated wiping of saliva from lips or chin, and frequent changes of swabs and even clothing throughout the day.22 Physical problems include peri-oral skin erosion, wet clothing, and, when excessive, damage to electronics (including speech computers) or other equipment.23
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