Botox Treatment
Parent/Whanāu Information
Spasticity Management Clinic
Your child has been referred to the Spasticity
Management Clinic for help with treating spasticity
(stiffness) in their muscles. There are several
different treatment options and the most
appropriate ones for your child will be discussed
with you. This fact sheet will provide you with
some information about one of the treatments
commonly known as Botox.
What is Botox?
Botox is a brand name for a toxin (Botulinum toxin
A) that is made in the laboratory from bacteria. It
can be very useful for treating spasticity in some
children with cerebral palsy and head injury. It is
used in small doses to help stop the muscle from
over-contracting (spasticity).
How does Botox work?
Botox works by blocking the release of the
chemical messenger to the nerve that makes the
muscle contract. The toxin causes a temporary
paralysis of the muscle at the injection site which
reduces spasticity and allows the muscle to stretch
and work better. The injection usually takes effect
within a few days and is then reversed naturally by
the body over the next 3-6 months. The nerve then
becomes active again so the spasticity returns, and
further treatment may be needed.
Why do we use Botox?
Botox helps relax the spastic muscles so they can
then begin to work differently. Botox is a
temporary treatment which wears off after 3-6
CapitalDocs ID: 1.102975 | Issue date: July 2016 | Review date: July 2019
Child Development Service
months. This is useful in children as they are
constantly growing and changing.
Every child will have different goals they want to
achieve with the injections and these will be
discussed with you. We may be trying to improve
your child’s walking, fitting into their orthotic or
encouraging them with activities such as getting
dressed and washed. We look at these goals again
after the injections to see if the Botox has made
anything easier.
Who do we use Botox with?
Botox is used to treat some children with cerebral
palsy or other neurological conditions. It is not
suitable for all children so we need to do an
assessment in clinic to choose which children will
benefit.
Physiotherapy (and sometimes Occupational
Therapy) are very important following Botox
injections to help strengthen and make the
muscles work better. If you cannot commit to
attending the follow up therapy sessions, the
injections may need to be postponed.
Are there any side effects?
Possible side-effects from this treatment include
bruising or bleeding at the injection site, allergic
reaction, flu-like illness and temporary changes in
bowel and bladder function. Botox is stabilised
with human albumin which is a blood product.
Sometimes muscles become weaker so your child
may find it harder to walk or they might fall more
frequently for a short time. Physiotherapy should
help with this. Your specialist will discuss the side
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effects with you prior to starting the treatment to
ensure you are fully informed. It is important to
know that for some children, Botox does not work.
What happens at clinic?
At clinic, your child will be assessed by a team
which may include a Rehabilitation Paediatrician,
an Orthopaedic surgeon, a Physiotherapist and an
Orthotist. We will assess your child’s muscles and
how they walk. We may need to take a video of
your child walking. This allows us to see exactly
how your child is moving. We will then discuss with
you if Botox would help and which muscles we
think would benefit.
What happens next?
If we think your child will benefit from Botox
injections, they will be given a date to return for
injections. These are done in the Children’s Day
Ward on a Friday under general anaesthetic. Your
child cannot have anything to eat after midnight
and clear fluids only until 6am on the day of the
injections. Your child will be admitted to the
Children’s Day Ward and seen briefly by the
Paediatrician before theatre. They will then go to
theatre for the injections. Your child will stay a
short while in the Recovery Room after the
injections before returning to the Children’s Day
Ward.
Some older children may have the injection under
a local anaesthetic however this will be discussed
with you to decide which is the best option.
If we don’t think that Botox will help, we may offer
you an appointment in another clinic, such as the
Orthopaedic clinic or ask you to come back in the
future for another assessment.
CapitalDocs ID: 1.102975 | Issue date: July 2016 | Review date: July 2019
Therapy
Your local Physiotherapist (and sometimes
Occupational Therapist) will discuss appointment
times with you before your child has their
injections. It is very important that you attend
these.
Casting
Sometimes serial casting is required following the
injections to help stretch out shortened muscles.
This will be done by your local therapist and usually
means your child has below knee plasters put on
the week following the injections. Your therapist
will discuss with you for how long the plasters will
be put on and how often they are changed. Your
child will be able to return to their usual level of
walking in them and go to school/preschool.
Follow up
You and your child will be asked to return for a
follow-up assessment 4-8 weeks after the
injections to see the effect of the Botox and
therapy. You will be sent an appointment for this.
Further questions
If you have any further questions or would like
more information regarding Botox or the
procedure, please contact your local therapist or
CDS on 04 918 2800.
This fact sheet gives general information only; please
discuss the individual treatment of your child with the
team at the Spasticity Management Clinic or with your
local therapist.
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